与患有乳腺癌的黑人和白人女性生存率差异相关的特征
Jeffrey H Silber1, Paul R Rosenbaum, Amy S Clark
1Center for Outcomes Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. silber@email.chop.edu
JAMA
|August 7, 2013
概括
乳腺癌存活率的种族差异在医疗保险受益者中仍然存在. 差异主要是由于癌症在诊断时的表现,而不是治疗变化.
科学领域:
- 在瘤学瘤学.
- 健康差异 在健康上的差异
- 流行病学 流行病学
背景情况:
- 乳腺癌存活率的种族差异是医疗保险人口中的一个重要问题.
- 了解这种差异的根本原因对于改善结果至关重要.
研究的目的:
- 调查乳腺癌存活率的种族差异主要是由初始呈现特征或随后治疗的变化驱动的.
- 分析65岁及以上被诊断患有乳腺癌的黑人和白人妇女的生存数据.
主要方法:
- 使用SEER-Medicare数据库进行的一项比较研究,分析了7,375名黑人妇女和匹配的白人对照,这些妇女在1991-2005年间被诊断出患有这种疾病.
- 根据人口统计,表现特征 (包括瘤阶段和等级) 和接受的治疗,患者被匹配.
- 五年生存率是主要的结果指标.
主要成果:
- 观察到黑人和白人女性之间5年生存率的初始绝对差异为12.9%.
- 在对表现特征进行匹配后,这种生存差距显著缩小至4.4%.
- 对治疗的进一步匹配将差距降至3.6%,表明呈现,而不是治疗是主要的驱动因素.
结论:
- 在SEER-Medicare数据库中,黑人和白人女性之间的乳腺癌存活率差异从1991年至2005年基本保持不变.
- 这些生存差异主要与诊断时疾病表现的变化有关.
- 治疗差异占观察到的生存差距的最小部分.
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