社会经济地位对德克萨斯州东南部癌症护理的影响：一项基于人群的回顾性队列研究。
Impact of socioeconomic status on cancer care in Southeast Texas: a retrospective population-based cohort study.
作者信息
Anwar Junaid, Thompson Jacob, Sarfraz Zouina, Terro Telice, Henry Sara, Blevins Samantha, Vasefi Maryam, Abdelhakeem Ahmed
机构信息
Department of Medicine, Baptist Hospitals of Southeast Texas, Beaumont, Texas, USA.
Department of Biology, Lamar University, Beaumont, Texas, USA.
出版信息
Proc (Bayl Univ Med Cent). 2024 Jul 22;37(5):782-793. doi: 10.1080/08998280.2024.2375489. eCollection 2024.
BACKGROUND
Gastrointestinal (GI) cancers are the third leading cause of cancer-related mortality worldwide. Disparities in healthcare frequently stem from variations in socioeconomic status (SES). This study investigated the influence of socioeconomic factors such as gender, race, age, and geography on time to treatment initiation (TTI) and survival outcomes.
METHODS
The study analyzed SES data, including age, race, geography, and insurance status, from GI cancer patients treated at Baptist Hospitals of Southeast Texas (BHSET) from 2012 to 2017. Logistic regression was performed for risk association. The primary outcomes were survival time and TTI.
RESULTS
Of 517 GI cancer patients, 359 had colorectal cancer. African Americans had higher treatment delays (odds ratio [OR]: 5.89, confidence interval [CI]: 4.02-8.62) than Caucasians (OR: 0.16, CI: 0.11-0.23). Patients >80 years had poorer survival (OR: 2.91, CI: 1.80-4.72) than younger ones. Those living 30 + miles from BHSET had longer TTI (OR: 1.85, CI: 1.19-2.87), especially within the colorectal cancer cohort (OR: 2.20, CI: 1.29-3.74). Medicare Advantage was linked to longer TTI (OR: 1.50, CI: 1.01-2.23). Medicare patients without supplemental insurance had lower survival overall (OR: 1.79, CI: 1.05-3.06) and among colorectal cancer patients (OR: 2.13, CI: 1.14-3.98).
CONCLUSION
Addressing SES disparities and implementing targeted interventions is imperative to ensure equitable access to timely and effective cancer care.
背景
胃肠道（GI）癌症是全球癌症相关死亡的第三大主要原因。医疗保健方面的差异往往源于社会经济地位（SES）的不同。本研究调查了性别、种族、年龄和地理位置等社会经济因素对治疗开始时间（TTI）和生存结果的影响。
方法
该研究分析了2012年至2017年在德克萨斯州东南部浸信会医院（BHSET）接受治疗的GI癌症患者的SES数据，包括年龄、种族、地理位置和保险状况。进行逻辑回归以分析风险关联。主要结局为生存时间和TTI。
结果
在517例GI癌症患者中，359例患有结直肠癌。非裔美国人的治疗延迟（优势比[OR]：5.89，置信区间[CI]：4.02 - 8.62）高于白种人（OR：0.16，CI：0.11 - 0.23）。80岁以上的患者生存情况（OR：2.91，CI：1.80 - 4.72）比年轻患者差。居住在距离BHSET 30多英里以外的患者TTI更长（OR：1.85，CI：1.19 - 2.87），尤其是在结直肠癌队列中（OR：2.20，CI：1.29 - 3.74）。医疗保险优势计划与更长的TTI相关（OR：1.50，CI：1.01 - 2.23）。没有补充保险的医疗保险患者总体生存情况较差（OR：1.79，CI：1.05 - 3.06），在结直肠癌患者中也是如此（OR：2.13，CI：1.14 - 3.98）。
结论
解决SES差异并实施有针对性的干预措施对于确保公平获得及时有效的癌症治疗至关重要。
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