UNDERSTANDING RACIAL DIFFERENCES--LUNG CANCER TREATMENT

黑人和白人患者之间的护理差距一直是 记录了一些慢性疾病的病史。巴赫博士提出了一个 旨在评估几种潜在机制的项目 观察到的现象。 黑人I/II期(早期)非小细胞肺癌患者 (非小细胞肺癌)比白人患者更不可能接受根治性手术 切除手术。这种治疗上的差异占了大多数 这些种族和民族之间目前存在的生存差距，以及 与观察到的一些其他严重的种族差距一致 医疗条件。目前，造成这些差距的根本原因是 仍然不确定。这项研究的目的是利用治疗早期的 将非小细胞肺癌分期作为了解黑人患者原因的典范 在较低的地区接受可能治愈的严重医疗条件 比类似的白人患者的发病率更高。确定以下潜在机制 这些差异应有助于设计有效的干预措施。 这项假设驱动的研究解决了黑人患者 接受手术的比率较低有两个原因：一是以医生为基础，二是 以病人为本。首先，医生对手术风险的评估不那么积极 在黑人中，因此建议减少手术次数。第二，一位黑人病人 如果医生不接受医生的建议，他就不太可能接受 在种族上与他一致。这项研究将使用SEER-Medicare挂钩 数据库，由从美国人收集的提供商特定信息扩展 医疗协会提供者文件和国家索赔历史文件。这个 数据库将被用来识别评价路径，然后是黑色 早期非小细胞肺癌的白人患者。一旦确定，就会出现 将对黑人和白人患者经历的评估过程进行评估， 以及在接受手术时提供者和患者种族之间的关联 将会受到考验。

Disparities in care among black and white patients have been documented for a number of chronic medical conditions. Dr. Bach proposes a project designed to evaluate several potential mechanisms underlying this observed phenomenon. Black patients with Stage I/II (early stage) non-small cell lung cancer (NSCLC) are less likely than white patients to undergo curative surgical resection. This disparity in treatment accounts for the majority of the survival gap that currently exists between these racial, ethnic groups, and is consistent with racial disparities observed for a number of other serious medical conditions. At present, the underlying causes for these disparities remain uncertain. The objective of this study is to use treatment of early stage NSCLC as a model for understanding the reasons why black patients undergo potentially curative treatment for serious medical conditions at lower rates than similar white patients. Identifying the underlying mechanisms of these disparities should facilitate the design of effective interventions. This hypothesis driven study addresses the supposition that black patients undergo surgery at lower rates for two reasons: one physician based, one patient based. First, physicians evaluate risk of surgery less aggressively in blacks and therefore recommend surgery less often. Second, a black patient is less likely to accept a physician's recommendation if that physician is not racially concordant with him. The study will use the SEER-Medicare linked database, augmented by provider specific information gleaned from the American Medical Association provider file and the National Claims History file. The database will be used to identify the paths of evaluation followed by black and white patients with early stage NSCLC. Once identified, differences in the evaluative process undergone by black and white patients will be assessed, and the association between provider and patient race on receipt of surgery will be tested.