Dataset Information

Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer.

ABSTRACT: Age, sex, and racial/ethnic disparities exist, but are understudied in pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether survival and treatment disparities persist after adjusting for demographic and clinical characteristics. Our study included PDAC patients diagnosed between 1992 and 2011. We used Cox regression to compare survival across age, sex, and race/ethnicity within early-stage and late-stage cancer subgroups, adjusting for marital status, urban location, socioeconomics, SEER region, comorbidities, stage, lymph node status, tumor location, tumor grade, diagnosis year, and treatment received. We used logistic regression to compare differences in treatment received across age, sex, and race/ethnicity. Among 20,896 patients, 84% were White, 9% Black, 5% Asian, and 2% Hispanic. Median age was 75; 56% were female and 53% had late-stage cancer. Among early-stage patients in the adjusted Cox model, older patient subgroups had worse survival compared with ages 66-69 (HR > 1.1, P < 0.01 for groups >69); no survival differences existed between sexes. Black (HR = 1.1, P = 0.01) and Hispanic (HR = 1.2, P < 0.01) patients had worse survival compared with White. Among late-stage cancer patients, patients over age 84 had worse survival than those aged 66-69 (HR = 1.1, P < 0.01), and males (HR = 1.08, P < 0.01) had worse survival than females; there were no racial/ethnic differences. Older age and minority race/ethnicity were associated with lower likelihood of receiving chemotherapy, radiation, and/or surgery. Age and racial/ethnic disparities in survival outcomes and treatment received exist for PDAC patients; these disparities persist after adjusting for differences in demographic and clinical characteristics.

SUBMITTER: Nipp R

PROVIDER: S-EPMC5806100 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer.

Nipp Ryan R Tramontano Angela C AC Kong Chung Yin CY Pandharipande Pari P Dowling Emily C EC Schrag Deborah D Hur Chin C

Cancer medicine 20180111 2

Age, sex, and racial/ethnic disparities exist, but are understudied in pancreatic adenocarcinoma (PDAC). We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database to determine whether survival and treatment disparities persist after adjusting for demographic and clinical characteristics. Our study included PDAC patients diagnosed between 1992 and 2011. We used Cox regression to compare survival across age, sex, and race/ethnicity within early-stage and late-stage ca ...[more]

PMID: 29322643

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Project description:BackgroundCriteria for low-dose CT scan lung cancer screening vary across guidelines. Knowledge of the eligible pool across demographic groups can enable policy and programmatic decision-making, particularly for disproportionately affected populations.Research questionWhat are the eligibility rates for low-dose CT scan screening according to sex and race or ethnicity and how do these rates relate to corresponding lung cancer incidence rates?Study design and methodsThis was a cross-sectional study using data from the 2015 National Health Interview Survey adult and cancer control supplement files. In addition to eligibility rates, the ratio of the eligibility rate to the lung cancer incidence rate in a given population group (eligibility to incidence [E-I] ratio) also was determined. Guidelines assessed were: Centers for Medicare and Medicaid Services, National Comprehensive Cancer Network, and US Preventive Services Task Force current or with expansion of age and smoking or quit thresholds. We also assessed a risk model (PLCOM2012 risk model).ResultsTotal numbers eligible based on current guidelines ranged from 8.3 to 13.3 million, representing 8.3% to 13.4% of the US population 50 to 80 years of age, and up to 17.5 million with expanded criteria. Overall eligibility rates on average were about 10 percentage points higher for men than women. For both men and women, and both overall and among ever smokers, non-Hispanic Whites had the highest eligibility rates across all guidelines, followed generally by non-Hispanic Blacks, and then Asians and Hispanics. Among both men and women, non-Hispanic Whites had the highest E-I ratios across all guidelines; non-Hispanic Black men had higher lung cancer incidence, but 30% to 50% lower E-I ratios, than non-Hispanic White men.InterpretationScreening eligibility rates vary widely across guidelines, with disparities evident in E-I ratios, including among non-Hispanic Black men, despite higher lung cancer burden. Consideration of smoking duration in risk assessment criteria may address current disparities.

Project description:OBJECTIVES:This study sought to describe the health status of outpatients with heart failure and reduced ejection fraction (HFrEF) by sex, race/ethnicity, and socioeconomic status (SES). BACKGROUND:Although a primary goal in treating patients with HFrEF is to optimize health status, whether disparities by sex, race/ethnicity, and SES exist is unknown. METHODS:In the CHAMP-HF (Change the Management of Patients with Heart Failure) registry, the associations among sex, race, and SES and health status, as measured by the Kansas City Cardiomyopathy Questionnaire-overall summary (KCCQ-os) score (range 0 to 100; higher scores indicate better health status) was compared among 3,494 patients from 140 U.S. clinics. SES was categorized by total household income. Hierarchical multivariate linear regression estimated differences in KCCQ-os score after adjusting for 31 patient characteristics and 10 medications. RESULTS:Overall mean KCCQ-os scores were 64.2 ± 24.0 but lower for women (29% of sample; 60.3 ± 24.0 vs. 65.9 ± 24.0, respectively; p < 0.001), for blacks (60.5 ± 25.0 vs. 64.9 ± 23.0, respectively; p < 0.001), for Hispanics (59.1 ± 21.0 vs. 64.9 ± 23.0, respectively; p < 0.001), and for those with the lowest income (<$25,000; mean: 57.1 vs. 63.1 to 74.7 for other income categories; p < 0.001). Fully adjusted KCCQ-os scores were 2.2 points lower for women (95% confidence interval [CI]: -3.8 to -0.6; p = 0.007), no different for blacks (p = 0.74), 4.0 points lower for Hispanics (95% CI: -6.6 to -1.3; p = 0.003), and lowest in the poorest patients (4.7 points lower than those with the highest income (95% CI: 0.1 to 9.2; p = 0.045; p for trend = 0.003). CONCLUSIONS:Among outpatients with HFrEF, women, blacks, Hispanics, and poorer patients had worse health status, which remained significant for women, Hispanics, and poorer patients in fully adjusted analyses. This suggests an opportunity to further optimize treatment to reduce these observed disparities.

Dataset Information

Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer.

Publications

Disparities in cancer outcomes across age, sex, and race/ethnicity among patients with pancreatic cancer.

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