美国印第安人/阿拉斯加土著人口中的直肠癌差异
Broc S Kelley1, Cibele B Carroll2, John M Hampton2
1Department of Medicine, Division of Hematology, Oncology and Palliative Care, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
美国印第安人/阿拉斯加原住民 (AI/AN) 被诊断患有直肠癌的个体较年轻,病情更为发达. 与白人患者相比,AI/AN种族与较低的整体存活率 (OS) 有关,这凸显了改善查和治疗准入的需要.
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:
- 之前的研究表明,与非西班牙裔白人 (NHW) 人群相比,患有结肠癌的美国印第安人/阿拉斯加土著人 (AI/AN) 个人的整体存活率 (OS) 较低.
- 在AI/AN人群中,直肠癌的人口统计和生存数据仍然不足.
研究的目的:
- 调查AI/AN和白色患者组之间直肠癌诊断和结果的差异.
- 为了确定这些人群之间的人口特征和直肠癌生存率的差异.
主要方法:
- 利用国家癌症数据库 (NCDB) 识别白人和AI/AN患者在2004年至2020年期间被诊断患有直肠腺癌.
- 进行未调整和调整的分析,以比较人口和临床特征,包括标准化差异 (stddiff).
- 使用卡普兰-梅尔方法和多变量考克斯比例危险建模,对II/III期直肠癌进行了生存分析.
主要成果:
- 确定了176,341例符合条件的病例 (0.6%AI/AN,99.4%白人).
- AI/AN患者的平均年龄较小 (59.9岁与64.5岁相比) 诊断出AI/AN患者,并且呈现出更晚期的疾病 (44.8%与43.7%相比).
- AI/AN患者不成比例地居住在收入较低的地区 (35.5%对15.1%),农村地区 (9.9%对2.2%) 和主要使用医疗补助 (14.3%对6.2%).
- 调整后的分析显示,AI/AN患者的死亡风险增加 (HR,1.14;95% CI,1.05-1.25;p=0.003).
结论:
- 患有直肠癌的AI/AN个体在较年轻时被诊断出患有更晚期疾病.
- 与白人患者相比,AI/AN种族独立地与较低的整体存活率有关.
- 未来的干预措施应优先考虑加强结直肠癌查和改善AI/AN人群的治疗机会,以改善生存结果.
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