Despite lower incidence rates, African American (AA) patients have shorter survival from breast cancer (BC) than white (W) patients. Multiple factors contribute to decreased survival, including screening disparities, later presentation, and access to care. Disparities in adverse events (AEs) may contribute to delayed or incomplete treatment, earlier recurrence, and shortened survival. Here, we analyzed the SEER-Medicare dataset, which captures claims from a variety of venues, in order to determine whether the cancer care venues affect treatment and associated adverse events. We investigated a study population whose claims are included in the Outpatient files, consisting of hospital and healthcare facility venues, and a study population from the National Claims History (NCH) files, consisting of claims from physicians, office practices, and other non-institutional providers. We demonstrated statistically and substantively significant venue-specific differences in treatment rates, drugs administered, and AEs from treatments between AA and W patients. We showed that AA patients in the NCH dataset received lower rates of treatment, but patients in the Outpatient dataset received higher rates of treatment than W patients. The rates of recorded AEs per treatment were higher in the NCH setting than in the Outpatient setting in all patients. AEs were consistently higher in AA patients than in W patients. AA patients had higher comorbidity indices and were younger than W patients, but these variables did not appear to play roles in the AE differences. The frequency of specific anticancer drugs administered in cancer- and venue-specific circumstances and their associated AEs varied between AA and W patients. The higher AE rates were due to slightly higher frequencies in the administration of drugs with higher associated AE rates in AA patients than in W patients. Our investigations demonstrate significant differences in treatment rates and associated AEs between AA and W patients with BC, depending on the venues of care, likely contributing to differences in outcomes.
尽管发病率较低，但非裔美国乳腺癌患者的生存期较白人患者更短。多种因素导致生存率下降，包括筛查差异、就诊时间较晚以及医疗资源可及性不足。不良事件发生率的差异可能导致治疗延迟或不完整、早期复发及生存期缩短。本研究通过分析涵盖多类医疗场所理赔数据的SEER-Medicare数据集，旨在探究癌症诊疗场所是否影响治疗及相关不良事件。我们分别考察了门诊文件数据集（包含医院及医疗机构场所）和国家理赔历史文件数据集（涵盖医师、诊所及其他非机构服务提供者）。研究发现，非裔与白人患者在治疗率、用药方案及治疗相关不良事件方面存在具有统计学意义和实质性的场所特异性差异。数据显示，国家理赔历史文件中非裔患者治疗率较低，而门诊文件中非裔患者治疗率高于白人患者。所有患者在国家理赔历史文件记录中的单位治疗不良事件发生率均高于门诊文件记录。非裔患者不良事件发生率持续高于白人患者。虽然非裔患者合并症指数更高且年龄更轻，但这些变量似乎未对不良事件差异产生影响。在特定癌症类型和诊疗场所背景下，抗癌药物使用频率及其相关不良事件在非裔与白人患者间存在差异。非裔患者不良事件发生率较高，源于其使用高不良事件风险药物的频率略高于白人患者。本研究证实，乳腺癌患者治疗率及相关不良事件存在显著的种族差异，这种差异与诊疗场所密切相关，可能是导致临床结局差异的重要因素。
Racial Disparities in Breast Cancer Treatments and Adverse Events in the SEER-Medicare Data
肿瘤(癌症)患者之家