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Wijayabahu AT, McGee-Avila JK, Shiels MS, Harsono AAH, Arend RC, Clarke MA. Five-Year Relative Survival Rates of Women Diagnosed with Uterine Cancer by County-Level Socioeconomic Status Overall and across Histology and Race/Ethnicity. Cancers (Basel) 2024; 16:2747. [PMID: 39123474 PMCID: PMC11311553 DOI: 10.3390/cancers16152747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/24/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Understanding socioeconomic factors contributing to uterine cancer survival disparities is crucial, especially given the increasing incidence of uterine cancer, which disproportionately impacts racial/ethnic groups. We investigated the impact of county-level socioeconomic factors on five-year survival rates of uterine cancer overall and by histology across race/ethnicity. We included 333,013 women aged ≥ 30 years with microscopically confirmed uterine cancers (2000-2018) from the Surveillance, Epidemiology, and End Results 22 database followed through 2019. Age-standardized five-year relative survival rates were compared within race/ethnicity and histology, examining the differences across tertiles of county-level percent (%)
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Affiliation(s)
- Akemi T. Wijayabahu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (J.K.M.-A.); (M.S.S.); (M.A.C.)
| | - Jennifer K. McGee-Avila
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (J.K.M.-A.); (M.S.S.); (M.A.C.)
| | - Meredith S. Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (J.K.M.-A.); (M.S.S.); (M.A.C.)
| | - Alfonsus Adrian H. Harsono
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (A.A.H.H.); (R.C.A.)
| | - Rebecca C. Arend
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233, USA; (A.A.H.H.); (R.C.A.)
| | - Megan A. Clarke
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA; (J.K.M.-A.); (M.S.S.); (M.A.C.)
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Codden RR, Sweeney C, Ofori-Atta BS, Herget KA, Wigren K, Edwards S, Carter ME, McCarty RD, Hashibe M, Doherty JA, Millar MM. Accuracy of patient race and ethnicity data in a central cancer registry. Cancer Causes Control 2024; 35:685-694. [PMID: 38019367 PMCID: PMC10960663 DOI: 10.1007/s10552-023-01827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE Race and Hispanic ethnicity data can be challenging for central cancer registries to collect. We evaluated the accuracy of the race and Hispanic ethnicity variables collected by the Utah Cancer Registry compared to self-report. METHODS Participants were 3,162 cancer survivors who completed questionnaires administered in 2015-2022 by the Utah Cancer Registry. Each survey included separate questions collecting race and Hispanic ethnicity, respectively. Registry-collected race and Hispanic ethnicity were compared to self-reported values for the same individuals. We calculated sensitivity and specificity for each race category and Hispanic ethnicity separately. RESULTS Survey participants included 323 (10.2%) survivors identifying as Hispanic, a lower proportion Hispanic than the 12.1% in the registry Hispanic variable (sensitivity 88.2%, specificity 96.5%). For race, 43 participants (1.4%) self-identified as American Indian or Alaska Native (AIAN), 32 (1.0%) as Asian, 23 (0.7%) as Black or African American, 16 (0.5%) Pacific Islander (PI), and 2994 (94.7%) as White. The registry race variable classified a smaller proportion of survivors as members of each of these race groups except White. Sensitivity for classification of race as AIAN was 9.3%, Asian 40.6%, Black 60.9%, PI 25.0%, and specificity for each of these groups was > 99%. Sensitivity and specificity for White were 98.8% and 47.4%. CONCLUSION Cancer registry race and Hispanic ethnicity data often did not match the individual's self-identification. Of particular concern is the high proportion of AIAN individuals whose race is misclassified. Continued attention should be directed to the accurate capture of race and ethnicity data by hospitals.
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Affiliation(s)
- Rachel R Codden
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
| | - Carol Sweeney
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Blessing S Ofori-Atta
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Kacey Wigren
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
| | - Sandra Edwards
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Rachel D McCarty
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mia Hashibe
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jennifer A Doherty
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Morgan M Millar
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Cancer Registry, University of Utah, Salt Lake City, UT, USA.
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
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Wang CP, McKinley M, Vu A, Yang JY, Gupta S, Gomez SL, Kim MK, Itzkowitz SH, Shah SC. Demographic Comparison of the Burden of Endoscopically Screenable Cancers in the United States. GASTRO HEP ADVANCES 2024; 3:482-490. [PMID: 39131721 PMCID: PMC11308758 DOI: 10.1016/j.gastha.2024.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 01/08/2024] [Indexed: 08/13/2024]
Abstract
Background and Aims Gastrointestinal cancer incidence varies by race and ethnicity. In the United States (US), there are screening guidelines for esophageal cancer (EC) and colorectal cancer (CRC), but not gastric cancer (GC). We compared GC, CRC, and EC incidence among the most populous racial and ethnic groups to inform US interception strategies. Methods We used SEER∗Stat to compare GC, CRC, and EC incidence rates across non-Hispanic White (NHW), non-Hispanic Black, Hispanic, and the 8 largest Asian American populations using the Surveillance, Epidemiology, and End Results 9 registries (2010-2014). Results Noncardia GC incidence was highest among Korean (18.7 cases per 100,000) and lowest among NHW (1.4 cases per 100,000) Americans. CRC incidence was highest among non-Hispanic Black, Southeast Asian, and Japanese (35.9, 34.2, and 33.8 per 100,000, respectively) Americans and lowest among South Asian Americans (18.9 per 100,000). EC incidence was greatest in NHW (4.7 per 100,000) and lowest in Filipino (1.2 per 100,000) Americans. The incidence of noncardia GC slightly exceeded colon cancer in Korean American men (25.5 vs 22.4 per 100,000). GC surpassed EC incidence in all non-White racial and ethnic groups. Conclusion The burden of GC, CRC, and EC differs based on race and ethnicity. Non-White racial and ethnic groups experience a disproportionate burden of GC for which systematic programs for cancer interception, similar to CRC and EC, are needed.
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Affiliation(s)
- Christina P. Wang
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Meg McKinley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Annie Vu
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Jeong Yun Yang
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samir Gupta
- GI Section, VA San Diego Healthcare System, San Diego, California
- Division of Gastroenterology, University of California San Diego, San Diego, California
| | - Scarlett L. Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Michelle Kang Kim
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Steven H. Itzkowitz
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shailja C. Shah
- GI Section, VA San Diego Healthcare System, San Diego, California
- Division of Gastroenterology, University of California San Diego, San Diego, California
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Janitz AE, Barber R, Campbell JE, Xu C, Pokala HR, Blanchard J, McNall-Knapp RY. Measuring disparities in event-free survival among children with acute lymphoblastic leukemia in an academic institute in Oklahoma, 2005-2019. Cancer Epidemiol 2022; 81:102275. [PMID: 36215916 PMCID: PMC10079780 DOI: 10.1016/j.canep.2022.102275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/09/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer. While there have been successes in the treatment of leukemia, less information is available on reasons for disparities in event-free survival (EFS) among underserved populations. METHODS We partnered with a children's hospital at an academic institution to abstract data from the institution's cancer registry, the state cancer registry, and electronic medical records on cancer diagnosis, treatment, and outcomes for children with ALL (n = 275) diagnosed from 2005 to 2019 prior to age 20. We evaluated the relation between 1) race/ethnicity, 2) distance to the children's hospital, and 3) area deprivation with EFS, defined as time from diagnosis to relapse, death, or the end of the study period. We evaluated differences in EFS using Kaplan-Meier analysis with the log-rank test. We used the Cox Proportional Hazards Model for multivariable survival analyses. RESULTS Most children were diagnosed with ALL under five years of age (45%) and with Pre-B ALL (87%). Twelve percent of children experienced a relapse and 5% died during induction or remission. EFS at 5 years was 82%. Non-Hispanic (NH) Black children had worse, though imprecise, EFS compared to NH White children (Adjusted Hazard Ratio: 2.07, 95% CI: 0.80, 5.38). Children residing in areas with higher deprivation had a higher adjusted hazard of poor outcomes compared to the least deprived areas, though estimates were imprecise (2nd quartile HR: 1.51, 3rd quartile: 1.85, 4th quartile: 1.62). We observed no association between distance to the children's hospital and EFS. CONCLUSION We observed poorer EFS for NH Black children and children residing in areas with high deprivation, though the estimates were not statistically significant. Our next steps include further evaluating socioeconomic factors in both rural and urban children to identify disparities in outcomes for children with ALL and other childhood cancers.
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Affiliation(s)
- Amanda E Janitz
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Rylee Barber
- Section of Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Chao Xu
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Hanumantha R Pokala
- Section of Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
| | - Jessica Blanchard
- Center for Applied Social Research, College of Arts and Sciences, University of Oklahoma, Norman, OK, 73072, United States.
| | - René Y McNall-Knapp
- Section of Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, United States.
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Obrochta CA, Parada H, Murphy JD, Nara A, Trinidad D, Araneta MR(H, Thompson CA. The impact of patient travel time on disparities in treatment for early stage lung cancer in California. PLoS One 2022; 17:e0272076. [PMID: 36197902 PMCID: PMC9534452 DOI: 10.1371/journal.pone.0272076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Travel time to treatment facilities may impede the receipt of guideline-concordant treatment (GCT) among patients diagnosed with early-stage non-small cell lung cancer (ES-NSCLC). We investigated the relative contribution of travel time in the receipt of GCT among ES-NSCLC patients. METHODS We included 22,821 ES-NSCLC patients diagnosed in California from 2006-2015. GCT was defined using the 2016 National Comprehensive Cancer Network guidelines, and delayed treatment was defined as treatment initiation >6 versus ≤6 weeks after diagnosis. Mean-centered driving and public transit times were calculated from patients' residential block group centroid to the treatment facilities. We used logistic regression to estimate risk ratios and 95% confidence intervals (CIs) for the associations between patients' travel time and receipt of GCT and timely treatment, overall and by race/ethnicity and neighborhood socioeconomic status (nSES). RESULTS Overall, a 15-minute increase in travel time was associated with a decreased risk of undertreatment and delayed treatment. Compared to Whites, among Blacks, a 15-minute increase in driving time was associated with a 24% (95%CI = 8%-42%) increased risk of undertreatment, and among Filipinos, a 15-minute increase in public transit time was associated with a 27% (95%CI = 13%-42%) increased risk of delayed treatment. Compared to the highest nSES, among the lowest nSES, 15-minute increases in driving and public transit times were associated with 33% (95%CI = 16%-52%) and 27% (95%CI = 16%-39%) increases in the risk of undertreatment and delayed treatment, respectively. CONCLUSION The benefit of GCT observed with increased travel times may be a 'Travel Time Paradox,' and may vary across racial/ethnic and socioeconomic groups.
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Affiliation(s)
- Chelsea A. Obrochta
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
| | - Humberto Parada
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
| | - James D. Murphy
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
| | - Atsushi Nara
- Department of Geography, San Diego State University, San Diego, California, United States of America
| | - Dennis Trinidad
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
| | | | - Caroline A. Thompson
- San Diego State University, School of Public Health, San Diego, California, United States of America
- University of California San Diego, School of Medicine, La Jolla, California, United States of America
- University of California San Diego, Moores Cancer Center, La Jolla, California, United States of America
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- * E-mail:
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Lee AW, Mendoza RA, Aman S, Hsu R, Liu L. Thyroid cancer incidence disparities among ethnic Asian American populations, 1990-2014. Ann Epidemiol 2021; 66:28-36. [PMID: 34774744 DOI: 10.1016/j.annepidem.2021.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/27/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Asian/Pacific Islanders (APIs) are at high risk of thyroid cancer, hence we examined thyroid cancer's incidence among disaggregated API subgroups in the United States (U.S.) to identify potential ethnic-specific disparities. METHODS Data from 1990 to 2014 in the Surveillance, Epidemiology, and End Results Program (SEER) were used to compare age-adjusted incidence rates (AAIRs) of thyroid cancer for seven API ethnic subgroups to non-Hispanic whites (NHWs) using incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Sex, age, tumor histotype, and year of diagnosis were considered. Trends were evaluated using average annual percent change (AAPC) statistics. RESULTS The highest AAIRs (per 100,000 person-years) were among Filipinos (female AAIR=20.49, male AAIR=7.06) and the lowest among Japanese (female AAIR=8.36, male AAIR=3.20). However, Filipinos showed significantly lower incidence of medullary tumors when compared to NHWs (female IRR=0.60, 95% CI 0.40-0.87, male IRR=0.26, 95% CI 0.26-0.51). The largest increasing trends were among Asian Indian/Pakistanis for females (AAPC=5.19, 95% CI 3.81 to 6.58) and Koreans for males (AAPC=4.57, 95% CI 3.14 to 6.03). CONCLUSIONS There are clear differences in thyroid cancer incidence and trends when U.S. API ethnic subgroups are examined separately. Disaggregating APIs in research can provide critical information for understanding thyroid cancer risk.
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Key Words
- average annual percent change, APC, annual percent change, API, Asian/Pacific Islander, ASIR, age-specific incidence rate, CI, confidence interval, ICD-O-3, International Classification of Diseases for Oncology, Third Edition, IRR, incidence rate ratio, NHW, non-Hispanic white, NOS, not otherwise specified002C SEER, Surveillance, Epidemiology, and End Results Program, U.S., United States
- thyroid cancer, Asian Americans, racial/ethnic disparities, AAIR, age-adjusted incidence rate, AAPC
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Affiliation(s)
- Alice W Lee
- Department of Public Health, California State University, Fullerton, 800 N. State College Blvd., KHS-127, Fullerton, CA, 92831, USA.
| | - Roy A Mendoza
- Department of Biological Sciences, California State University, Fullerton, 800 N. State College Blvd., MH-112, Fullerton, CA, 92831, USA
| | - Shehla Aman
- Department of Public Health, California State University, Fullerton, 800 N. State College Blvd., KHS-127, Fullerton, CA, 92831, USA
| | - Robert Hsu
- Department of Oncology, Keck School of Medicine, University of Southern California, 1975 Zonal Ave., Los Angeles, CA, 90033, USA
| | - Lihua Liu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, USA; Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, 1441 Eastlake Ave., Los Angeles, CA, 90033, USA
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Obrochta CA, Murphy JD, Tsou MH, Thompson CA. Disentangling Racial, Ethnic, and Socioeconomic Disparities in Treatment for Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:1546-1553. [PMID: 34108139 PMCID: PMC8338765 DOI: 10.1158/1055-9965.epi-20-1728] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/12/2021] [Accepted: 05/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Colorectal cancer is curable if diagnosed early and treated properly. Black and Hispanic patients with colorectal cancer are more likely to experience treatment delays and/or receive lower standards of care. Socioeconomic deprivation may contribute to these disparities, but this has not been extensively quantified. We studied the interrelationship between patient race/ethnicity and neighborhood socioeconomic status (nSES) on receipt of timely appropriate treatment among patients with colorectal cancer in California. METHODS White, Black, and Hispanic patients (26,870) diagnosed with stage I-III colorectal cancer (2009-2013) in the California Cancer Registry were included. Logistic regression models were used to examine the association of race/ethnicity and nSES with three outcomes: undertreatment, >60-day treatment delay, and >90-day treatment delay. Joint effect models and mediation analysis were used to explore the interrelationships between race/ethnicity and nSES. RESULTS Hispanics and Blacks were at increased risk for undertreatment [Black OR = 1.39; 95% confidence interval (CI) = 1.23-1.57; Hispanic OR = 1.17; 95% CI = 1.08-1.27] and treatment delay (Black/60-day OR = 1.78; 95% CI = 1.57-2.02; Hispanic/60-day OR = 1.50; 95% CI = 1.38-1.64) compared with Whites. Of the total effect (OR = 1.15; 95% CI = 1.07-1.24) of non-white race on undertreatment, 45.71% was explained by nSES. CONCLUSIONS Lower nSES patients of any race were at substantially higher risk for undertreatment and treatment delay, and racial/ethnic disparities are reduced or eliminated among non-white patients living in the highest SES neighborhoods. Racial and ethnic disparities persisted after accounting for neighborhood socioeconomic status, and between the two, race/ethnicity explained a larger portion of the total effects. IMPACT This research improves our understanding of how socioeconomic deprivation contributes to racial/ethnic disparities in colorectal cancer.
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Affiliation(s)
- Chelsea A Obrochta
- School of Public Health, San Diego State University, San Diego, California
- University of California San Diego, School of Medicine, San Diego, California
| | - James D Murphy
- University of California San Diego, Moores Cancer Center, San Diego, California
| | - Ming-Hsiang Tsou
- Department of Geography, San Diego State University, San Diego, California
- Center for Human Dynamics in the Mobile Age, San Diego State University, San Diego, California
| | - Caroline A Thompson
- School of Public Health, San Diego State University, San Diego, California.
- University of California San Diego, School of Medicine, San Diego, California
- University of California San Diego, Moores Cancer Center, San Diego, California
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Tarver ME. Race and Ethnicity in Real-World Data Sources: Considerations for Medical Device Regulatory Efforts. J Prim Care Community Health 2021; 12:2150132721994040. [PMID: 33682511 PMCID: PMC7940773 DOI: 10.1177/2150132721994040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/14/2022] Open
Abstract
Real-world evidence is increasingly being collected in our interconnected world. This information can provide insights on how medical products are impacting the daily lives of patients, translating into public health consequences. Understanding the demographic characteristics of patients contributing health information to real-world data sources is critical to determining the safety and effectiveness of medical products for specific populations. Race and ethnicity are recorded inconsistently in different real-world data sources, with many lacking reliable information on these variables. To better leverage all forms of real-world data to inform medical device evaluation, accurate and consistent collection of information from different racial and ethnic subgroups is necessary.
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Affiliation(s)
- Michelle E. Tarver
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD, USA
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Shah SC, McKinley M, Gupta S, Peek RM, Martinez ME, Gomez SL. Population-Based Analysis of Differences in Gastric Cancer Incidence Among Races and Ethnicities in Individuals Age 50 Years and Older. Gastroenterology 2020; 159:1705-1714.e2. [PMID: 32771406 PMCID: PMC7680373 DOI: 10.1053/j.gastro.2020.07.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS There are racial and ethnic differences in the incidence of gastric adenocarcinoma worldwide and in the US. Based on a decision analysis, screening for noncardia gastric adenocarcinoma might be cost-effective for non-White individuals 50 years or older. However, a lack of precise, contemporary information on gastric adenocarcinoma incidence in specific anatomic sites for this age group has impeded prevention and early detection programs in the US. We aimed to estimate the differences in gastric adenocarcinoma incidence in specific anatomic sites among races and ethnicities in individuals 50 years or older. METHODS We analyzed California Cancer Registry data from 2011 through 2015 to estimate incidences of gastric adenocarcinoma in specific anatomic sites for non-Hispanic White (NHW), non-Hispanic Black, Hispanic, and the 7 largest Asian American populations. We calculated the differential incidence between non-White groups and NHW using incidence rate ratios and 95% confidence intervals (CIs). RESULTS Compared with NHW subjects, all non-White groups had significantly higher incidences of noncardia gastric adenocarcinoma; the incidence was highest among Korean American men 50 years and older (70 cases per 100,000). Compared with NHW subjects 50 years and older, the risk of noncardia gastric adenocarcinoma was 1.8-fold (95% CI, 1.37-2.31) to 7.3-fold (95% CI, 5.73-9.19) higher in most non-White groups and 12.0-fold (95% CI, 9.96-14.6) to 14.5-fold (95% CI, 12.5-16.9) higher among Korean American men and women 50 years and older, respectively. Compared with NHW men 50 years and older, all non-White men, except Japanese and Korean American men, had a significantly lower risk of cardia gastric adenocarcinoma. CONCLUSIONS We identified several-fold differences in incidences of gastric adenocarcinoma in specific anatomic sites among racial and ethnic groups, with significant age and sex differences. These findings can be used to develop targeted risk reduction programs for gastric adenocarcinoma.
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Affiliation(s)
- Shailja C Shah
- Division of Gastroenterology, Veterans Affairs Tennessee Valley Health System, Nashville, Tennessee; Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Meg McKinley
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California
| | - Samir Gupta
- Section of Gastroenterology, Veterans Affairs San Diego Healthcare System, San Diego, California; Moores Cancer Center, University of California San Diego, La Jolla, California; Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Richard M Peek
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Maria Elena Martinez
- Moores Cancer Center, University of California San Diego, La Jolla, California; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
| | - Scarlett L Gomez
- Greater Bay Area Cancer Registry, University of California San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California
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Poulson M, Neufeld M, Geary A, Kenzik K, Sanchez SE, Dechert T, Kimball S. Intersectional Disparities Among Hispanic Groups in COVID-19 Outcomes. J Immigr Minor Health 2020; 23:4-10. [PMID: 33090300 PMCID: PMC7579850 DOI: 10.1007/s10903-020-01111-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2020] [Indexed: 01/03/2023]
Abstract
Previous geographically limited studies have shown differential impact of COVID-19 on Hispanic individuals. Data were obtained from the Centers for Disease Control and Prevention. We performed multivariate Poisson regression assessing risk of hospitalization and death in Hispanic White (HW), Hispanic Black (HB), and Hispanic Multiracial/Other (HM) groups compared to non-Hispanic Whites (NHW). The relative risk of hospitalization was 1.35, 1.58, and 1.50 (p < 0.001) for HW, HB, and HM individuals respectively when compared to NHW. Relative risk of death was 1.36, 1.72, 1.68 (p < 0.001) times higher in HW, HB, and HM compared to NHW. HW, HB, and HM individuals also had significantly increased risk of requiring mechanical ventilation and ICU admission when compared to NHW. Hispanic individuals are more likely to be hospitalized and die from COVID-19 infection than White, which underscores the need for more precise data and policies aimed at unique Hispanic groups to decrease disparities.
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Affiliation(s)
- Michael Poulson
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Miriam Neufeld
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Alaina Geary
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Kelly Kenzik
- Department of Surgery, Boston Medical Center, Boston, USA.,Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sabrina E Sanchez
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Tracey Dechert
- Department of Surgery, Boston Medical Center, Boston, USA.,Boston University School of Medicine, Boston, USA
| | - Sarah Kimball
- Boston University School of Medicine, Boston, USA. .,Immigrant and Refugee Health Center, Boston Medical Center, 801 Massachusetts Ave, 6th Floor, Boston, MA, 02119, USA.
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11
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Geris JM, Spector LG. Race, ethnicity, and socioeconomic differences in incidence of pediatric embryonal tumors in the United States. Pediatr Blood Cancer 2020; 67:e28582. [PMID: 32672899 PMCID: PMC7674242 DOI: 10.1002/pbc.28582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The etiology of childhood cancers and its social patterning remains largely unknown. Accounting for socioeconomic status (SES) when exploring the association between race/ethnicity and cancer incidence is necessary to better understand such etiology. We aimed to investigate differences in the incidence of embryonal tumors (ETs) by SES and race/ethnicity in the United States using population-based registries of the Surveillance, Epidemiology, and End Results (SEER) Program. PROCEDURE Children with ETs aged 0-19 years diagnosed between 2000 and 2015 were ascertained from the census tract-level SEER database. SES was measured using a tract-level composite index. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) by SES quintile and race/ethnicity were estimated using multivariable Poisson regression models. RESULTS The majority of tumors had lower incidence among nonwhite children compared with non-Hispanic (NH) white children, after controlling for SES. NH blacks had a higher incidence of Wilms tumor than NH whites (IRR: 1.26; 95% CI, 1.13-1.39). There was an increasing linear trend (P = 0.0001) across increasing SES quintile for embryonal rhabdomyosarcoma after controlling for race/ethnicity. Effect modification by race/ethnicity of the relationship between SES and tumor incidence was observed for several groups. Hispanics had a significant, linear trend (P = 0.0005) in the incidence of Wilms tumor, while Asian/Pacific Islanders experienced a significant inverse trend (P = 0.0002). CONCLUSIONS Results from this study suggest differences in the incidence of several ETs by race/ethnicity and that these differences may be modified by SES. Investigation of potential risk factors that are socially patterned is warranted.
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Affiliation(s)
- Jennifer M. Geris
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis MN
| | - Logan G. Spector
- Division of Epidemiology & Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis MN
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Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 1.5 million individuals and led to over 91, 000 deaths in the United States (US) alone as of May 20th, 2020. Minority populations, however, continue to be a high-risk population to contract the SARS-CoV-2 infection. While socioeconomic inequality may help to explain why minority ethnic populations are contracting the SARS-CoV-2 in larger proportions, the reason for elevated mortality rates in African Americans is still unknown. African Americans are less likely than whites to utilize high-quality hospitals, ambulatory care services, and regular primary care providers; this is most likely a result of barriers to accessing high quality treatment, as African Americans have substantially higher uninsured rates. However, previous reports have shown that regardless of insurance status, African Americans are more likely to be directed toward lower quality treatment plans compared to their white counterparts, and that physicians carry implicit biases that negatively impact treatment regimens for these minority populations. While income, education, and access to healthcare should be revised in due time, in the short term physicians should do everything possible to learn about implicit biases that may exist in healthcare, as the first step to minimize implicit biases is to recognize that they exist.
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13
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Moghavem N, Oh DL, Santiago-Rodríguez EJ, Tate WJ, Gomez SL, Thomas R. Impact of the Patient Protection and Affordable Care Act on 1-year survival in glioblastoma patients. Neurooncol Adv 2020; 2:vdaa080. [PMID: 32743549 PMCID: PMC7388609 DOI: 10.1093/noajnl/vdaa080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) treatment requires access to complex medical services, and the Patient Protection and Affordable Care Act (ACA) sought to expand access to health care, including complex oncologic care. Whether the implementation of the ACA was subsequently associated with changes in 1-year survival in GBM is not known. METHODS A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database. We identified patients with the primary diagnosis of GBM between 2008 and 2016. A multivariable-adjusted Cox proportional hazards model was developed using patient and clinical characteristics to determine the main outcome: the 1-year cumulative probability of death by state expansion status. RESULTS A total of 25 784 patients and 14 355 deaths at 1 year were identified and included in the analysis, 49.7% were older than 65 at diagnosis. Overall 1-year cumulative probability of death for GBM patients in non-expansion versus expansion states did not significantly worsen over the 2 time periods (2008-2010: hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.04-1.19; 2014-2016: HR 1.18, 95% CI 1.09-1.27). In GBM patients younger than age 65 at diagnosis, there was a nonsignificant trend toward the poorer 1-year cumulative probability of death in non-expansion versus expansion states (2008-2010: HR 1.09, 95% CI 0.97-1.22; 2014-2016: HR 1.23, 95% CI 1.09-1.40). CONCLUSIONS No differences were found over time in survival for GBM patients in expansion versus non-expansion states. Further study may reveal whether GBM patients diagnosed younger than age 65 in expansion states experienced improvements in 1-year survival.
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Affiliation(s)
- Nuriel Moghavem
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, USA
| | - Debora L Oh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Eduardo J Santiago-Rodríguez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - William J Tate
- Stanford School of Medicine, Stanford University, Palo Alto, California, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Reena Thomas
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, California, USA
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14
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Lee AW, Navajas EE, Liu L. Clear differences in ovarian cancer incidence and trends by ethnicity among Asian Americans. Cancer Epidemiol 2019; 61:142-149. [PMID: 31254796 PMCID: PMC7428826 DOI: 10.1016/j.canep.2019.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/05/2019] [Accepted: 06/12/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Across major races in the United States (U.S.), ovarian cancer incidence is low among Asian American women. However, this observation aggregates Asian Americans as a single group despite their heterogeneity. Disaggregating the ethnic Asian population will produce more useful information to better understand ovarian cancer incidence among Asian women in the U.S. METHODS Data from the Surveillance, Epidemiology, and End Results Program from 1990 to 2014 were used to compare age-adjusted incidence rates (AAIRs, per 100,000 women) for ovarian cancer for the six largest U.S. Asian ethnicities (Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese) to non-Hispanic whites (NHWs). The race/ethnicity-specific AAIRs were calculated by time period and histotype. We examined the magnitude and direction of AAIR trends using average annual percent change (AAPC) statistics. RESULTS All Asian ethnicities had significantly lower ovarian cancer incidence rates than NHWs. However, among Asian ethnicities, Asian Indians/Pakistanis had the highest rate of ovarian cancer (AAIR = 10.51, 95% CI: 9.65-11.42) while Koreans had the lowest (AAIR = 7.23, 95% CI: 6.62-7.88). Clear cell ovarian cancer had significantly higher incidence rates among Chinese, Filipino, and Japanese women than NHW women (incidence rate ratio (IRR) = 1.49, 95% CI: 1.29-1.72, IRR = 1.30, 95% CI: 1.12-1.51, IRR = 1.64, 95% CI: 1.36-1.97, respectively). Incidence trends also differed by Asian ethnicity with significant decreases only observed for Chinese (AAPC = -1.49, 95% CI: -2.22 to -0.74) and Japanese (AAPC = -1.75, 95% CI: -2.57 to -0.92). CONCLUSIONS Examining Asian Americans as a single group results in missed ethnic-specific disparities in ovarian cancer, hence disaggregating this heterogeneous population in future research is warranted.
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Affiliation(s)
- Alice W Lee
- Department of Public Health, California State University, Fullerton, Fullerton, CA, United States.
| | - Emma E Navajas
- Department of Public Health, California State University, Fullerton, Fullerton, CA, United States
| | - Lihua Liu
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
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15
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Sung H, DeSantis CE, Fedewa SA, Kantelhardt EJ, Jemal A. Breast cancer subtypes among Eastern‐African–born black women and other black women in the United States. Cancer 2019; 125:3401-3411. [DOI: 10.1002/cncr.32293] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Hyuna Sung
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| | - Carol E. DeSantis
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| | - Stacey A. Fedewa
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
| | - Eva J. Kantelhardt
- Department of Gynecology, Institute of Medical Epidemiology, Biometrics and Informatics Martin‐Luther University Halle Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research American Cancer Society Atlanta Georgia
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16
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Gupta S, Tao L, Murphy JD, Camargo MC, Oren E, Valasek MA, Gomez SL, Martinez ME. Race/Ethnicity-, Socioeconomic Status-, and Anatomic Subsite-Specific Risks for Gastric Cancer. Gastroenterology 2019; 156:59-62.e4. [PMID: 30267713 PMCID: PMC6309455 DOI: 10.1053/j.gastro.2018.09.045] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 01/22/2023]
Abstract
Anatomic subsite risk factors for gastric cancer differ substantially, and subsite-specific distribution of risk factors (such as Helicobacter pylori) can vary by race and ethnicity and neighborhood socioeconomic status (nSES). We examined differences in gastric cancer incidence by subsite, stratified by race and ethnicity and nSES, using Surveillance Epidemiology and End Results Program 2000-2014 data for 77,881 incident gastric cancer cases (cardia, n = 23,651; non-cardia, n = 35,825; overlapping or unspecified, n = 18,405). Compared with non-Hispanic whites, cardia cancer multivariable-adjusted incidence rate ratios were 35%-47% lower for blacks, Hispanics, Asian or Pacific Islanders, and American Indian or Alaska Natives; conversely, non-cardia incidence rate ratios were 1.7- to 3.9-fold higher for blacks, Hispanics, Asian or Pacific Islanders, and American Indian or Alaska Natives. Higher adjusted incidence rate ratios with decreasing nSES (lowest vs highest nSES quintile) were observed for all gastric (1.3-fold) and non-cardia (1.3-fold) cancers but were borderline significant for cardia cancers (1.1-fold). In conclusion, non-cardia cancer incidence is higher in minorities and varies by nSES, but cardia cancer incidence is higher in non-Hispanic whites and does not vary substantially by nSES. Clarifying reasons for higher cardia risk in non-Hispanic whites and targeted interventions to address non-cardia cancer risk in minorities could lessen the burden of gastric cancer.
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Affiliation(s)
- Samir Gupta
- Division of Gastroenterology, VA San Diego Healthcare System, San Diego, California; Division of Gastroenterology, UC San Diego, La Jolla, California; Moores Cancer Center, UC San Diego, La Jolla, California.
| | - Li Tao
- Department of Epidemiology and Biostatistics, UC San Francisco, San Francisco, California
| | - James D Murphy
- Moores Cancer Center, UC San Diego, La Jolla, California; Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, California
| | - M Constanza Camargo
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Eyal Oren
- Division of Epidemiology, School of Public Health, San Diego State University, San Diego, California
| | - Mark A Valasek
- Department of Pathology, UC San Diego, La Jolla, California
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, UC San Francisco, San Francisco, California; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco
| | - Maria Elena Martinez
- Moores Cancer Center, UC San Diego, La Jolla, California; Department of Family Medicine and Public Health, UC San Diego, La Jolla, California
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17
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Garcia S, Pruitt SL, Singal AG, Murphy CC. Colorectal cancer incidence among Hispanics and non-Hispanic Whites in the United States. Cancer Causes Control 2018; 29:1039-1046. [PMID: 30155605 PMCID: PMC6628724 DOI: 10.1007/s10552-018-1077-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/23/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Colorectal cancer (CRC) incidence has declined over the past two decades; however, these declines have not occurred equally in all populations. To better understand the impact of CRC among Hispanics, we examined incidence trends by age and Hispanic ethnicity. METHODS Using data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program, we estimated CRC incidence rates during the period 2001-2014, and across all 50 U.S. states. We estimated incidence rates in younger (age < 50 years) and older (age ≥ 50 years) adults by anatomic subsite and stage at diagnosis, separately for non-Hispanic Whites and Hispanic Whites. RESULTS CRC incidence rates declined among older (age ≥ 50 years) Whites and Hispanics, but Whites experienced a greater decline (31% vs. 27% relative decline among Hispanics). In contrast to older adults, there were continued increases in CRC incidence from 2001 to 2014 among younger (age 20-49 years) adults. The largest relative increases in incidence occurred in Hispanics aged 20-29 years (90% vs. 50% relative increase among Whites). CONCLUSIONS Opposing incidence trends in younger versus older Hispanics may reflect generational differences in CRC risk by birth cohort, as well as environmental exposures and lifestyle-related risk factors associated with immigration and acculturation.
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Affiliation(s)
- Sandra Garcia
- Departments of Clinical Sciences and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Sandi L Pruitt
- Departments of Clinical Sciences and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Amit G Singal
- Departments of Clinical Sciences and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Caitlin C Murphy
- Departments of Clinical Sciences and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
- Division of Epidemiology, Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.
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Racial and Ethnic Disparities in Treatment Outcomes of Patients with Ruptured or Unruptured Intracranial Aneurysms. J Racial Ethn Health Disparities 2018; 6:345-355. [PMID: 30264335 DOI: 10.1007/s40615-018-0530-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study is to examine how health outcomes varied by treatment selection and race/ethnicity among hospitalized US patients with ruptured or unruptured IAs. METHODS A retrospective cohort study was conducted using a sample of 62,224 hospital discharges from the 2002-2012 Nationwide Inpatient Sample. Logistic regression models evaluated treatment selection as predictor of in-hospital survival (IHS: "yes," "no") and length of stay (LOS ≤ 7 days, > 7 days), overall and across racial/ethnic groups, taking hospital- and patient-level confounders into account, while stratifying by IA rupture status. RESULTS Compared to surgical clipping, endovascular coiling was associated with better IHS, after controlling for confounders. Compared to surgical clipping, LOS ≤ 7 days was less likely in patients with combination of treatments and more likely among patients with endovascular coiling as well as balloon- or stent-assisted coiling. Observed relationships varied significantly by race and ethnicity for IHS, but not for LOS ≤ 7 days. Whereas combination of treatments were associated with worse IHS than surgical clipping among Blacks alone, endovascular coiling was associated with better IHS than surgical clipping among White and Other racial/ethnic subgroups. These relationships were for the most part consistent among patients with and without IA rupture. CONCLUSIONS Racial and ethnic subgroups of IA patients experienced differential IHS by treatment selection, irrespective of IA rupture status. Prospective cohort studies are needed to further elucidate these racial and ethnic disparities, while collecting data on IA size, location, and morphology as well as Hunt and Hess grade for ruptured IA.
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19
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Parikh M, Galkin M, Brunson A, Keegan T, Chew HK. Breast cancer-specific survival in patients with HER2-positive, node-negative T1a and T1b breast cancer. Cancer Treat Res Commun 2018; 16:38-44. [PMID: 31299001 DOI: 10.1016/j.ctarc.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 06/08/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE There is limited data on prognosis of node-negative (N0), HER2-positive (HER2+) small breast cancers. We evaluated breast cancer-specific survival (BCSS) among women diagnosed with T1a/T1b, N0 tumors in California between 2000-2004 and 2005-2012, eras before and after approval of adjuvant trastuzumab. PATIENTS AND METHODS 45,346 women diagnosed with T1a/b, N0 tumors between January 1, 2000 and December 31, 2012 were identified in the California Cancer Registry (CCR); approximately 10% were HER2 + , and 80% hormone receptor positive (ER and/or PR+). Primary outcome was BCSS, analyzed in 2000-2004 and 2005-2012. Multivariable Cox proportional hazards regression was used to calculate hazard ratios and 95% confidence intervals for mortality, and separately conducted for hormone receptor positive and negative tumors. Kaplan-Meier curves compared BCSS by HER2 status. RESULTS While BCSS in this cohort exceeded 90%, a significantly higher hazard of breast cancer death was observed in women with HER2+ tumors in the 2000-2004 era. There was no difference in outcomes between T1a and T1b tumors. Women with ER/PR+ tumors had lower hazards of death in both eras, but HER2+ tumors were associated with a higher hazard of death in the 2000-2004 era. Among women with hormone receptor negative tumors, HER2 positive disease was associated with a lower hazard of death in the 2005-2012 era. CONCLUSION Within this large cohort of T1a/b N0 breast cancers from the CCR, HER2+ tumors were associated with a significantly worse BCSS in the era before adjuvant trastuzumab. A balanced discussion regarding HER2-directed therapies is needed between patient and clinician.
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Affiliation(s)
- Mamta Parikh
- Department of Internal Medicine, Division of Hematology Oncology, UC Davis School of Medicine, United States
| | - Maria Galkin
- Department of Internal Medicine, UC Davis School of Medicine, United States
| | - Ann Brunson
- Center for Oncology and Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, UC Davis School of Medicine, United States
| | - Theresa Keegan
- Center for Oncology and Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, UC Davis School of Medicine, United States
| | - Helen K Chew
- Department of Internal Medicine, Division of Hematology Oncology, UC Davis School of Medicine, United States.
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20
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Mazereeuw MV, Withrow DR, Nishri ED, Tjepkema M, Vides E, Marrett LD. Cancer incidence and survival among Métis adults in Canada: results from the Canadian census follow-up cohort (1992-2009). CMAJ 2018; 190:E320-E326. [PMID: 29555862 PMCID: PMC5860893 DOI: 10.1503/cmaj.170272] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Métis people are 1 of 3 Aboriginal groups recognized by the Canadian constitution. We estimated site-specific incidence rates and survival for the most common cancers among Métis adults in Canada and compared these with rates among non-Aboriginal adults in Canada. METHODS We examined responses to the 1991 long-form census, including self-reported Métis ancestry linked to national mortality and cancer databases for followup from 1992 to 2009. We estimated age-standardized incidence rates and 5-year relative survival. We determined relative risk (RR) of cancer among Métis and non-Aboriginal adults using Poisson regression, and estimated excess mortality rate ratios using ethnicity-specific life tables. RESULTS For all cancers and both sexes combined, cancer incidence was similar for Métis and non-Aboriginal adults. However, incidence was significantly higher among Métis adults than among non-Aboriginal adults for the following cancers: female breast (RR 1.18, 95% confidence interval [CI] 1.02-1.37), lung (RR 1.34, 95% CI 1.18-1.52), liver (RR 2.09, 95% CI 1.30-3.38), larynx (RR 1.60, 95% CI 1.03-2.48), gallbladder (RR 2.35, 95% CI 1.12-4.96) and cervix (RR 1.84, 95% CI 1.23-2.76). Métis people had poorer survival for prostate cancer (excess mortality rate ratio 2.60, 95% CI 1.52-4.46). INTERPRETATION We found higher incidence for several cancers and poorer survival after prostate cancer among Métis adults. Several of these disparities may be related to lifestyle factors (including tobacco use, obesity and lack of cancer screening), providing evidence to support development of public health policy and health care to address cancer burden in the Métis people of Canada.
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Affiliation(s)
- Maegan V Mazereeuw
- Prevention and Cancer Control (Mazereeuw, Withrow, Nishri, Marrett), Cancer Care Ontario; Dalla Lana School of Public Health (Withrow, Marrett), University of Toronto, Toronto, Ont.; Health Analysis Division (Tjepkema), Statistics Canada; Métis National Council (Vides), Ottawa, Ont.
| | - Diana R Withrow
- Prevention and Cancer Control (Mazereeuw, Withrow, Nishri, Marrett), Cancer Care Ontario; Dalla Lana School of Public Health (Withrow, Marrett), University of Toronto, Toronto, Ont.; Health Analysis Division (Tjepkema), Statistics Canada; Métis National Council (Vides), Ottawa, Ont
| | - E Diane Nishri
- Prevention and Cancer Control (Mazereeuw, Withrow, Nishri, Marrett), Cancer Care Ontario; Dalla Lana School of Public Health (Withrow, Marrett), University of Toronto, Toronto, Ont.; Health Analysis Division (Tjepkema), Statistics Canada; Métis National Council (Vides), Ottawa, Ont
| | - Michael Tjepkema
- Prevention and Cancer Control (Mazereeuw, Withrow, Nishri, Marrett), Cancer Care Ontario; Dalla Lana School of Public Health (Withrow, Marrett), University of Toronto, Toronto, Ont.; Health Analysis Division (Tjepkema), Statistics Canada; Métis National Council (Vides), Ottawa, Ont
| | - Eduardo Vides
- Prevention and Cancer Control (Mazereeuw, Withrow, Nishri, Marrett), Cancer Care Ontario; Dalla Lana School of Public Health (Withrow, Marrett), University of Toronto, Toronto, Ont.; Health Analysis Division (Tjepkema), Statistics Canada; Métis National Council (Vides), Ottawa, Ont
| | - Loraine D Marrett
- Prevention and Cancer Control (Mazereeuw, Withrow, Nishri, Marrett), Cancer Care Ontario; Dalla Lana School of Public Health (Withrow, Marrett), University of Toronto, Toronto, Ont.; Health Analysis Division (Tjepkema), Statistics Canada; Métis National Council (Vides), Ottawa, Ont
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Press DJ, Miller ME, Liederbach E, Yao K, Huo D. De novo metastasis in breast cancer: occurrence and overall survival stratified by molecular subtype. Clin Exp Metastasis 2017; 34:457-465. [PMID: 29288366 DOI: 10.1007/s10585-017-9871-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/20/2017] [Indexed: 01/21/2023]
Abstract
Breast cancer molecular subtypes, categorized jointly by hormone receptors (HR) and human epidermal growth factor-2 (HER2), are utilized to guide systemic therapy. We hypothesized distinct patterns of de novo metastasis and overall survival by molecular subtype using a retrospective cohort of 399,772 women in the National Cancer Database diagnosed with first primary invasive breast cancer between 2010 and 2014, of whom 13,924 were diagnosed with de novo metastasis from 2010 to 2013 and had follow up data. The relationship of molecular subtype with patient and tumor characteristics, including site of de novo metastasis, were examined using Chi-squared tests. Kaplan-Meier and Cox proportional hazards analyses were used to examine overall survival by molecular subtype. Bone was the most frequent de novo metastatic site for all molecular subtypes. Compared to HR+/HER2-, patients with HR-/HER2+ experienced 4.5, 3.0, and 6.0 times the de novo brain, lung, and liver metastasis respectively. In survival analyses of women diagnosed with de novo metastasis, the mortality risk relative to HR+/HER2- was twice as high for triple-negative (hazard ratio = 2.02, 95% CI 1.89-2.16) and modestly lower for HR+/HER2+ (hazard ratio = 0.83, 95% CI 0.78-0.88). The median survival difference between metastatic patients with and without chemotherapy was 28.6 months in HR+/HER2+ and 28.2 months in HR-/HER2+, but only 10.9 months in triple-negative and 5.2 months in HR+/HER2-. In conclusion, despite unfavorable patterns of de novo metastasis, HER2+ breast cancers had relatively better survival in recent years, probably due to treatment differences. Utilizing molecular subtype and site of de novo metastasis may predict prognosis and guide treatment.
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Affiliation(s)
- David J Press
- Department of Public Health Sciences, The University of Chicago, 5841 South Maryland Avenue, MC 2000, Chicago, IL, 60637, USA
| | - Megan E Miller
- Department of Surgery, Case Western Reserve University Hospitals, Cleveland, OH, USA
| | - Erik Liederbach
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Katherine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, 5841 South Maryland Avenue, MC 2000, Chicago, IL, 60637, USA.
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Press DJ, Ibraheem A, Dolan ME, Goss KH, Conzen S, Huo D. Racial disparities in omission of oncotype DX but no racial disparities in chemotherapy receipt following completed oncotype DX test results. Breast Cancer Res Treat 2017; 168:207-220. [PMID: 29181717 DOI: 10.1007/s10549-017-4587-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/18/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE To examine racial/ethnic disparities in Oncotype DX (ODX) testing among patients with node-negative, estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancers and possible racial/ethnic disparities in chemotherapy receipt following ODX testing within Recurrence Score (RS) category (Not Done, Low, Intermediate, High), as well as chemotherapy receipt time trends within RS categories. METHODS A retrospective cohort list of 125,288 women who were potentially indicated for ODX testing from 2010 to 2014 was obtained using the National Cancer Database. We fit multivariate logistic regression predicting chemotherapy receipt, adjusting for clinical factors, patient demographic factors, and hospital-level factors, separately by RS category, and calculated odds ratios (OR) and 95% confidence intervals (CI), as well as time trends. RESULTS Overall, ODX testing was completed for 46.1% of Non-Hispanic (NH) Whites, 43.9% of NH Blacks, and 41.7% of Hispanics. Among patients who did not receive ODX testing, NH Black and Hispanic women both experienced statistically significant increases in chemotherapy receipt relative to NH White women (NH Black OR 1.23; 95% CI 1.11-1.37; Hispanic OR 1.23; 95% CI 1.07-1.42). However, among patients with ODX results, no statistically significant racial/ethnic differences in chemotherapy receipt were observed within strata of RS category. Trend analyses demonstrated increasing adherence to national guidelines for ODX testing. CONCLUSIONS We identified racial disparities in omission of ODX testing but no differences in chemotherapy receipt if ODX test results were obtained, suggesting increasing access to ODX testing may improve racial equality in efficacious use of adjuvant chemotherapy for ER-positive HER2-negative breast cancer.
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Affiliation(s)
- David J Press
- Department of Public Health Sciences, The University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA.
| | - Abiola Ibraheem
- Section of Hematology/Oncology, Department of Medicine Chicago, University of Chicago, Chicago, IL, USA
| | - M Eileen Dolan
- Section of Hematology/Oncology, Department of Medicine Chicago, University of Chicago, Chicago, IL, USA
| | - Kathleen H Goss
- University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Suzanne Conzen
- Section of Hematology/Oncology, Department of Medicine Chicago, University of Chicago, Chicago, IL, USA
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
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Martínez ME, Gomez SL, Tao L, Cress R, Rodriguez D, Unkart J, Schwab R, Nodora JN, Cook L, Komenaka I, Li C. Contribution of clinical and socioeconomic factors to differences in breast cancer subtype and mortality between Hispanic and non-Hispanic white women. Breast Cancer Res Treat 2017; 166:185-193. [PMID: 28698973 PMCID: PMC5647237 DOI: 10.1007/s10549-017-4389-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/07/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess tumor subtype distribution and the relative contribution of clinical and sociodemographic factors on breast cancer survival between Hispanic and non-Hispanic whites (NHWs). METHODS We analyzed data from the California Cancer Registry, which included 29,626 Hispanic and 99,862 NHW female invasive breast cancer cases diagnosed from 2004 to 2014. Logistic regression was used to assess ethnic differences in tumor subtype, and Cox proportional hazard modeling to assess differences in breast cancer survival. RESULTS Hispanics compared to NHWs had higher odds of having triple-negative (OR = 1.29; 95% CI 1.23-1.35) and HER2-overexpressing tumors (OR = 1.19; 95% CI 1.14-1.25 [HR-] and OR = 1.39; 95% CI 1.31-1.48 [HR+]). In adjusted models, Hispanic women had a higher risk of breast cancer mortality than NHW women (mortality rate ratio [MRR] = 1.24; 95% CI 1.19-1.28). Clinical factors accounted for most of the mortality difference (MRR = 1.05; 95% CI 1.01-1.09); however, neighborhood socioeconomic status (SES) and health insurance together accounted for all of the mortality difference (MRR = 1.01; 95% CI 0.97-1.05). CONCLUSIONS Addressing SES disparities, including increasing access to health care, may be critical to overcoming poorer breast cancer outcomes in Hispanics.
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Affiliation(s)
- María Elena Martínez
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr., #0901, La Jolla, CA, 92093-0829, USA.
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA.
| | - Scarlett L Gomez
- Cancer Prevention Institute of California, Fremont, CA, USA
- Stanford Cancer Institute, Palo Alto, CA, USA
| | - Li Tao
- Cancer Prevention Institute of California, Fremont, CA, USA
| | - Rosemary Cress
- California Cancer Registry, Public Health Institute, Sacramento, CA, USA
| | - Danielle Rodriguez
- California Cancer Registry, Public Health Institute, Sacramento, CA, USA
| | - Jonathan Unkart
- Department of Surgery, University of California, San Diego, La Jolla, CA, USA
| | - Richard Schwab
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Jesse N Nodora
- Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Dr., #0901, La Jolla, CA, 92093-0829, USA
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Linda Cook
- Department of Internal Medicine, University of New Mexico and the University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA
| | - Ian Komenaka
- Maricopa Medical Center, Department of Surgery, Phoenix, AZ, USA
| | - Christopher Li
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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Wang L, Gomez SL, Yasui Y. Racial and Ethnic Differences in Socioeconomic Position and Risk of Childhood Acute Lymphoblastic Leukemia. Am J Epidemiol 2017; 185:1263-1271. [PMID: 28369160 DOI: 10.1093/aje/kww164] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/29/2016] [Indexed: 11/14/2022] Open
Abstract
Racial and ethnic differences in associations between socioeconomic position (SEP) and risk of childhood acute lymphoblastic leukemia (ALL) were investigated using data from population-based cancer registries in the Surveillance, Epidemiology, and End Results Program in the United States. The study included 8,383 ALL cases diagnosed at age ≤19 years in 2000-2010. Census tract-level composite SEP index in quintiles was assigned based on residence at the time of diagnosis. Incidence rate ratios and 95% confidence intervals associated with SEP and race/ethnicity, adjusted for sex, age, and year of diagnosis, were estimated using Poisson regression models. The incidence rate of childhood ALL was negatively associated with SEP among Hispanics but was positively associated among children of other races/ethnicities. As compared with the lowest SEP, the adjusted incidence rate ratios for children with the highest SEP were 1.29 (95% confidence interval (CI): 1.15, 1.44) for non-Hispanic whites, 1.67 (95% CI: 1.20, 2.34) for non-Hispanic blacks, 1.57 (95% CI: 1.17, 2.09) for Asians/Pacific Islanders, 2.33 (95% CI: 0.93, 5.83) for American Indians/Alaska Natives, and 0.70 (95% CI: 0.60, 0.81) for Hispanics. The findings of a reverse association in Hispanics need to be confirmed and further explained in future studies using different measures of SEP.
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Affiliation(s)
- Linwei Wang
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (Linwei Wang, Yutaka Yasui)
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California (Scarlett Lin Gomez)
- Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University, Stanford, California (Scarlett Lin Gomez)
- Stanford Cancer Institute, Stanford, California (Scarlett Lin Gomez)
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada (Linwei Wang, Yutaka Yasui)
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Martínez ME, Unkart JT, Tao L, Kroenke CH, Schwab R, Komenaka I, Gomez SL. Prognostic significance of marital status in breast cancer survival: A population-based study. PLoS One 2017; 12:e0175515. [PMID: 28475579 PMCID: PMC5419505 DOI: 10.1371/journal.pone.0175515] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/27/2017] [Indexed: 01/02/2023] Open
Abstract
Research shows that married cancer patients have lower mortality than unmarried patients but few data exist for breast cancer. We assessed total mortality associated with marital status, with attention to differences by race/ethnicity, tumor subtype, and neighborhood socioeconomic status (nSES). We included, from the population-based California Cancer Registry, women ages 18 and older with invasive breast cancer diagnosed between 2005 and 2012 with follow-up through December 2013. We estimated mortality rate ratios (MRR) and 95% confidence intervals (CI) for total mortality by nSES, race/ethnicity, and tumor subtype. Among 145,564 breast cancer cases, 42.7% were unmarried at the time of diagnosis. In multivariable-adjusted models, the MRR (95% CI) for unmarried compared to married women was 1.28 (1.24-1.32) for total mortality. Significant interactions were observed by race/ethnicity (P<0.001), tumor subtype (P<0.001), and nSES (P = 0.009). Higher MRRs were observed for non-Hispanic whites and Asians/Pacific Islanders than for blacks or Hispanics, and for HR+/HER2+ tumors than other subtypes. Assessment of interactive effect between marital status and nSES showed that unmarried women living in low SES neighborhoods had a higher risk of dying compared with married women in high SES neighborhoods (MRR = 1.60; 95% CI: 1.53-1.67). Unmarried breast cancer patients have higher total mortality than married patients; the association varies by race/ethnicity, tumor subtype, and nSES. Unmarried status should be further evaluated as a breast cancer prognostic factor. Identification of underlying causes of the marital status associations is needed to design interventions that could improve survival for unmarried breast cancer patients.
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Affiliation(s)
- María Elena Martínez
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States of America
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States of America
| | - Jonathan T. Unkart
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States of America
- Department of Surgery, University of California, San Diego, La Jolla, CA, United States of America
| | - Li Tao
- Cancer Prevention Institute of California, Fremont, CA, United States of America
| | - Candyce H. Kroenke
- Kaiser Permanente, Division of Research, Oakland, CA, United States of America
| | - Richard Schwab
- Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States of America
| | - Ian Komenaka
- Maricopa Medical Center, Department of Surgery, Phoenix, AZ, United States of America
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, CA, United States of America
- Stanford Cancer Institute, Palo Alto, CA, United States of America
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Pruitt SL, Tiro JA, Xuan L, Lee SJC. Hispanic and Immigrant Paradoxes in U.S. Breast Cancer Mortality: Impact of Neighborhood Poverty and Hispanic Density. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1238. [PMID: 27983668 PMCID: PMC5201379 DOI: 10.3390/ijerph13121238] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 12/26/2022]
Abstract
To test the Hispanic and Immigrant Paradoxes-i.e., survival advantages despite a worse risk factor profile-and the modifying role of neighborhood context, we examined associations between patient ethnicity, birthplace, neighborhood Hispanic density and neighborhood poverty among 166,254 female breast cancer patients diagnosed 1995-2009 in Texas, U.S. Of all, 79.9% were non-Hispanic White, 15.8% Hispanic U.S.-born, and 4.2% Hispanic foreign-born. We imputed birthplace for the 60.7% of Hispanics missing birthplace data using multiple imputation. Shared frailty Cox proportional hazard models (patients nested within census tracts) adjusted for age, diagnosis year, stage, grade, histology, urban/rural residence, and local mammography capacity. Whites (vs. U.S.-born Hispanics) had increased all-cause and breast cancer mortality. Foreign-born (vs. U.S.-born) Hispanics had increased all-cause and breast cancer mortality. Living in higher Hispanic density neighborhoods was generally associated with increased mortality, although associations differed slightly in magnitude and significance by ethnicity, birthplace, and neighborhood poverty. We found no evidence of an Immigrant Paradox and some evidence of a Hispanic Paradox where protective effects were limited to U.S.-born Hispanics. Contrary to prior studies, foreign birthplace and residence in higher Hispanic density neighborhoods were associated with increased mortality. More research on intersections between ethnicity, birthplace and neighborhood context are needed.
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Affiliation(s)
- Sandi L Pruitt
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX 75235, USA.
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX 75235, USA.
| | - Lei Xuan
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Simon J Craddock Lee
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
- Harold C. Simmons Comprehensive Cancer Center, Dallas, TX 75235, USA.
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Withrow DR, Racey CS, Jamal S. A critical review of methods for assessing cancer survival disparities in indigenous population. Ann Epidemiol 2016; 26:579-591. [PMID: 27431064 DOI: 10.1016/j.annepidem.2016.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/27/2016] [Accepted: 06/06/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE An increasing cancer burden among indigenous populations has led to a growing literature about survival disparities between indigenous and nonindigenous persons. We aim to describe and appraise methods used to measure cancer survival in indigenous persons in the United States, Canada, Australia, and New Zealand. METHODS We searched Medline, Web of Science, and EMBASE for articles published between 1990 and 2015 that estimated survival in populations indigenous to one of these four countries. We gathered information about data sources, analytical methods, and the extent to which threats to validity were discussed. RESULTS The search retrieved 83 articles. The most common approach to survival analysis was cause-specific survival (n = 49). Thirty-eight articles measured all-cause survival and 11 measured excess mortality attributable to cancer (relative survival). Three sources of information bias common to all studies (ethnic misclassification, incomplete case ascertainment, and incomplete death ascertainment) were acknowledged in a minority of articles. CONCLUSIONS The methodological considerations we present here are shared with studies of cancer survival across other subpopulations. We urge future researchers on this and related topics to clearly describe their data sources, to justify analytic choices, and to fully discuss the potential impact of those choices on the results and interpretation.
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Affiliation(s)
- Diana R Withrow
- Aboriginal Cancer Control Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada; Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - C Sarai Racey
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sehar Jamal
- Aboriginal Cancer Control Unit, Prevention and Cancer Control, Cancer Care Ontario, Toronto, Canada
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28
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Validity of Race, Ethnicity, and National Origin in Population-based Cancer Registries and Rapid Case Ascertainment Enhanced With a Spanish Surname List. Med Care 2016; 54:e1-8. [PMID: 23938598 DOI: 10.1097/mlr.0b013e3182a30350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accurate information regarding race, ethnicity, and national origins is critical for identifying disparities in the cancer burden. OBJECTIVES To examine the use of a Spanish surname list to improve the quality of race-related information obtained from rapid case ascertainment (RCA) and to estimate the accuracy of race-related information obtained from cancer registry records collected by routine reporting. SUBJECTS Self-reported survey responses of 3954 participants from California enrolled in the Cancer Care Outcomes Research and Surveillance Consortium. MEASURES Sensitivity, specificity, positive predictive value, and percent agreement. We used logistic regression to identify predictors of underreporting and overreporting of a race/ethnicity. RESULTS Use of the Spanish surname list increased the sensitivity of RCA for Latino ethnicity from 37% to 83%. Sensitivity for cancer registry records collected by routine reporting was ≥95% for whites, blacks, and Asians, and specificity was high for all groups (86%-100%). However, patterns of misclassification by race/ethnicity were found that could lead to biased cancer statistics for specific race/ethnicities. Discordance between self-reported and registry-reported race/ethnicity was more likely for women, Latinos, and Asians. CONCLUSIONS Methods to improve race and ethnicity data, such as using Spanish surnames in RCA and instituting data collection guidelines for hospitals, are needed to ensure minorities are accurately represented in clinical and epidemiological research.
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29
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Martínez ME, Anderson K, Murphy JD, Hurley S, Canchola AJ, Keegan THM, Cheng I, Clarke CA, Glaser SL, Gomez SL. Differences in marital status and mortality by race/ethnicity and nativity among California cancer patients. Cancer 2016; 122:1570-8. [PMID: 27065455 PMCID: PMC5523959 DOI: 10.1002/cncr.29886] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/01/2015] [Accepted: 12/11/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND It has been observed that married cancer patients have lower mortality rates than unmarried patients, but data for different racial/ethnic groups are scarce. The authors examined the risk of overall mortality associated with marital status across racial/ethnic groups and sex in data from the California Cancer Registry. METHODS California Cancer Registry data for all first primary invasive cancers diagnosed from 2000 through 2009 for the 10 most common sites of cancer-related death for non-Hispanic whites (NHWs), blacks, Asians/Pacific Islanders (APIs), and Hispanics were used to estimate multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for marital status in relation to overall mortality by race/ethnicity and sex. The study cohort included 393,470 male and 389,697 female cancer patients and 204,007 and 182,600 deaths from all causes, respectively, through December 31, 2012. RESULTS All-cause mortality was higher in unmarried patients than in married patients, but there was significant variation by race/ethnicity. Adjusted HRs (95% CIs) ranged from 1.24 (95% CI, 1.23-1.26) in NHWs to 1.11 (95% CI, 1.07-1.15) in APIs among males and from 1.17 (95% CI, 1.15-1.18) in NHWs to 1.07 (95% CI, 1.04-1.11) in APIs among females. All-cause mortality associated with unmarried status compared with married status was higher in US-born API and Hispanic men and women relative to their foreign-born counterparts. CONCLUSIONS For patients who have the cancers that contribute most to mortality, being unmarried is associated with worse overall survival compared with being married, with up to 24% higher mortality among NHW males but only 6% higher mortality among foreign-born Hispanic and API females. Future research should pursue the identification of factors underlying these associations to inform targeted interventions for unmarried cancer patients. Cancer 2016;122:1570-8. © 2016 American Cancer Society.
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Affiliation(s)
- María Elena Martínez
- Moores Cancer Center, University of California, San Diego, La Jolla, California
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Kristin Anderson
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - James D Murphy
- Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Susan Hurley
- Cancer Prevention Institute of California, Fremont, California
| | | | - Theresa H M Keegan
- Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis, Sacramento, California
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, California
- Stanford Cancer Institute, Stanford, California
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford, California
| | - Sally L Glaser
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford, California
| | - Scarlett L Gomez
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy (Epidemiology), School of Medicine, Stanford, California
- Stanford Cancer Institute, Stanford, California
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Gomez SL, Yang J, Lin SW, McCusker M, Sandler A, Patel M, Cheng I, Wakelee HA, Clarke CA. Lung Cancer Survival Among Chinese Americans, 2000 to 2010. J Glob Oncol 2016; 2:30-38. [PMID: 28717680 PMCID: PMC5497738 DOI: 10.1200/jgo.2015.000539] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Despite being the leading cause of cancer death, no prior studies have characterized survival patterns among Chinese Americans diagnosed with lung cancer. This study was conducted to identify factors associated with survival after lung cancer in a contemporary cohort of Chinese patients with lung cancer. METHODS The study design is a prospective descriptive analysis of population-based California Cancer Registry data. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) for overall mortality. Participants were Chinese American residents diagnosed with first primary invasive lung cancer from 2000 to 2010 (2,216 men and 1,616 women). RESULTS Among Chinese men, decreased mortality was associated with care at a National Cancer Institute cancer center (HR, 0.85; 95% CI, 0.73 to 0.99) and adenocarcinoma versus small-cell carcinoma (HR, 0.78; 95% CI, 0.65 to 0.92). Women had better survival compared with men (HR, 0.82; 95% CI, 0.75 to 0.89), with mortality associated with never married versus currently married status (HR, 1.36; 95% CI, 1.11 to 1.66), lower versus higher neighborhood socioeconomic status (HR, 1.38; 95% CI, 1.10 to 1.72 comparing lowest to highest quintile), care at a cancer center (HR, 0.80; 95% CI, 0.67 to 0.96), and squamous cell relative to small-cell carcinoma (HR, 1.60; 95% CI, 1.04 to 2.48). CONCLUSION Focusing on factors associated with marital status, community socioeconomic status, and characteristics unique to National Cancer Institute-designated cancer centers may help to identify potential strategies for improving the length of survival for Chinese Americans.
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Affiliation(s)
- Scarlett Lin Gomez
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Juan Yang
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Shih-Wen Lin
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Margaret McCusker
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Alan Sandler
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Manali Patel
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Iona Cheng
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Heather A. Wakelee
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
| | - Christina A. Clarke
- Scarlett Lin Gomez, Juan Yang, Iona Cheng, and Christina A. Clarke, Cancer Prevention Institute of California, Fremont; Scarlett Lin Gomez and Christina A. Clarke, Stanford School of Medicine; Scarlett Lin Gomez, Manali Patel, Iona Cheng, Heather A. Wakelee, and Christina A. Clarke, Stanford Cancer Institute, Stanford; and Shih-Wen Lin, Margaret McCusker, and Alan Sandler, Genentech, South San Francisco, CA
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Butwick AJ, Blumenfeld YJ, Brookfield KF, Nelson LM, Weiniger CF. Racial and Ethnic Disparities in Mode of Anesthesia for Cesarean Delivery. Anesth Analg 2016; 122:472-9. [PMID: 26797554 PMCID: PMC4724639 DOI: 10.1213/ane.0000000000000679] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Racial and ethnic disparities have been identified in the provision of neuraxial labor analgesia. These disparities may exist in other key aspects of obstetric anesthesia care. We sought to determine whether racial/ethnic disparities exist in mode of anesthesia for cesarean delivery (CD). METHODS Women who underwent CD between 1999 and 2002 at 19 different obstetric centers in the United States were identified from the Maternal-Fetal Medicine Units Network Cesarean Registry. Race/ethnicity was categorized as: Caucasian, African American, Hispanic, and Non-Hispanic Others (NHOs). Mode of anesthesia was classified as neuraxial anesthesia (spinal, epidural, or combined spinal-epidural anesthesia) or general anesthesia. To account for obstetric and non-obstetric covariates that may have influenced mode of anesthesia, multiple logistic regression analyses were performed by using sequential sets of covariates. RESULTS The study cohort comprised 50,974 women who underwent CD. Rates of general anesthesia among racial/ethnic groups were as follows: 5.2% for Caucasians, 11.3% for African Americans, 5.8% for Hispanics, and 6.6% for NHOs. After adjustment for obstetric and non-obstetric covariates, African Americans had the highest odds of receiving general anesthesia compared with Caucasians (adjusted odds ratio [aOR] = 1.7; 95% confidence interval [CI], 1.5-1.8; P < 0.001). The odds of receiving general anesthesia were also higher among Hispanics (aOR = 1.1; 95% CI, 1.0-1.3; P = 0.02) and NHOs (aOR = 1.2; 95% CI, 1.0-1.4; P = 0.03) compared with Caucasians, respectively. In our sensitivity analysis, we reconstructed the models after excluding women who underwent neuraxial anesthesia before general anesthesia. The adjusted odds of receiving general anesthesia were similar to those in the main analysis: African Americans (aOR = 1.7; 95% CI, 1.5-1.9; P < 0.001); Hispanics (aOR = 1.2; 95% CI, 1.1-1.4; P = 0.006); and NHOs (aOR = 1.2; 95% CI, 1.0-1.5; P = 0.05). CONCLUSIONS Based on data from the Cesarean Registry, African American women had the highest odds of undergoing general anesthesia for CD compared with Caucasian women. It is uncertain whether this disparity exists in current obstetric practice.
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Affiliation(s)
- Alexander J Butwick
- From the *Department of Anesthesia, Stanford University School of Medicine, Stanford, California; †Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California; ‡Department of Health Research Policy, Stanford University School of Medicine, Stanford, California; and §Hadassah Hebrew University Medical Center, Jerusalem, Israel
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Lee SJC, Grobe JE, Tiro JA. Assessing race and ethnicity data quality across cancer registries and EMRs in two hospitals. J Am Med Inform Assoc 2015; 23:627-34. [PMID: 26661718 DOI: 10.1093/jamia/ocv156] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 09/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Measurement of patient race/ethnicity in electronic health records is mandated and important for tracking health disparities. OBJECTIVE Characterize the quality of race/ethnicity data collection efforts. METHODS For all cancer patients diagnosed (2007-2010) at two hospitals, we extracted demographic data from five sources: 1) a university hospital cancer registry, 2) a university electronic medical record (EMR), 3) a community hospital cancer registry, 4) a community EMR, and 5) a joint clinical research registry. The patients whose data we examined (N = 17 834) contributed 41 025 entries (range: 2-5 per patient across sources), and the source comparisons generated 1-10 unique pairs per patient. We used generalized estimating equations, chi-squares tests, and kappas estimates to assess data availability and agreement. RESULTS Compared to sex and insurance status, race/ethnicity information was significantly less likely to be available (χ(2 )> 8043, P < .001), with variation across sources (χ(2 )> 10 589, P < .001). The university EMR had a high prevalence of "Unknown" values. Aggregate kappa estimates across the sources was 0.45 (95% confidence interval, 0.45-0.45; N = 31 276 unique pairs), but improved in sensitivity analyses that excluded the university EMR source (κ = 0.89). Race/ethnicity data were in complete agreement for only 6988 patients (39.2%). Pairs with a "Black" data value in one of the sources had the highest agreement (95.3%), whereas pairs with an "Other" value exhibited the lowest agreement across sources (11.1%). DISCUSSION Our findings suggest that high-quality race/ethnicity data are attainable. Many of the "errors" in race/ethnicity data are caused by missing or "Unknown" data values. CONCLUSIONS To facilitate transparent reporting of healthcare delivery outcomes by race/ethnicity, healthcare systems need to monitor and enforce race/ethnicity data collection standards.
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Affiliation(s)
- Simon J Craddock Lee
- Department of Clinical Sciences, University of Texas, Southwestern Medical Center, Dallas, TX, USA Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - James E Grobe
- Department of Clinical Sciences, University of Texas, Southwestern Medical Center, Dallas, TX, USA
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas, Southwestern Medical Center, Dallas, TX, USA Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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Wang L, Bhatia S, Gomez SL, Yasui Y. Differential inequality trends over time in survival among U.S. children with acute lymphoblastic leukemia by race/ethnicity, age at diagnosis, and sex. Cancer Epidemiol Biomarkers Prev 2015; 24:1781-8. [PMID: 26377194 DOI: 10.1158/1055-9965.epi-15-0639] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/26/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is unclear how inequalities in survival among children with acute lymphoblastic leukemia (ALL) have changed over time in different race/ethnicity groups. METHODS Children diagnosed with a first primary malignant ALL at ages 0 to 19 years in 1975-2010 in the nine Surveillance, Epidemiology, and End Results cancer registries were included. Cumulative ALL mortalities were compared, and multivariable Cox regression analyses were applied to estimate ALL mortality HRs associated with race/ethnicity, age at diagnosis, and sex, adjusting for each other, within each diagnosis period (1975-1983, 1984-1991, 1992-1999, and 2000-2010). RESULTS Compared with non-Hispanic-whites (NH-whites), the HR in non-Hispanic-blacks (NH-blacks) dropped to 1.21 [95% confidence interval (CI), 0.74-1.96] in 2000-2010 from the largest inequality in 1984-1991 (HR, 2.09; 95% CI, 1.57-2.79); the HR in Hispanics increased, however, from 1.28 (95% CI, 0.98-1.66) in 1975-1983 to 1.95 (95% CI, 1.48-2.58) in 2000-2010. Asian/Pacific Islanders (API) and American Indian/Alaska Natives (AIAN) had HRs of 1.39 (95% CI, 0.92-2.11) and 2.31 (95% CI, 1.13-4.74), respectively, in 2000-2010 with nonstatistically significant increases over time. In 2000-2010, compared with NH-white counterparts, NH-blacks and APIs diagnosed at 1-9 years, Hispanics diagnosed at 1-9 and 10-19 years, and AIANs diagnosed at 10-19 years all had about twice the ALL mortality hazard rates; inequality was observed among API boys (HR, 1.61; 95% CI, 1.00-2.60) but not API girls. CONCLUSIONS Survival inequalities changed differently across subgroups of children with ALL. IMPACT Underlying causes of the differential trends need to be examined, such that targeted interventions can be developed to reduce inequalities.
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Affiliation(s)
- Linwei Wang
- School of Public Health, University of Alberta, Alberta, Canada
| | - Smita Bhatia
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford School of Medicine and Stanford Cancer Institute, Stanford, California
| | - Yutaka Yasui
- School of Public Health, University of Alberta, Alberta, Canada.
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Andrews RM. Statewide Hospital Discharge Data: Collection, Use, Limitations, and Improvements. Health Serv Res 2015; 50 Suppl 1:1273-99. [PMID: 26150118 PMCID: PMC4545332 DOI: 10.1111/1475-6773.12343] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To provide an overview of statewide hospital discharge databases (HDD), including their uses in health services research and limitations, and to describe Agency for Healthcare Research and Quality (AHRQ) Enhanced State Data grants to address clinical and race-ethnicity data limitations. PRINCIPAL FINDINGS Almost all states have statewide HDD collected by public or private data organizations. Statewide HDD, based on the hospital claim with state variations, contain useful core variables and require minimal collection burden. AHRQ's Healthcare Cost and Utilization Project builds uniform state and national research files using statewide HDD. States, hospitals, and researchers use statewide HDD for many purposes. Illustrating researchers' use, during 2012-2014, HSR published 26 HDD-based articles on health policy, access, quality, clinical aspects of care, race-ethnicity and insurance impacts, economics, financing, and research methods. HDD have limitations affecting their use. Five AHRQ grants focused on enhancing clinical data and three grants aimed at improving race-ethnicity data. CONCLUSION ICD-10 implementation will significantly affect the HDD. The AHRQ grants, information technology advances, payment policy changes, and the need for outpatient information may stimulate other statewide HDD changes. To remain a mainstay of health services research, statewide HDD need to keep pace with changing user needs while minimizing collection burdens.
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Affiliation(s)
- Roxanne M Andrews
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and QualityRockville, MD
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Gomez SL, Yang J, Lin SW, McCusker M, Sandler A, Cheng I, Wakelee HA, Patel M, Clarke CA. Incidence trends of lung cancer by immigration status among Chinese Americans. Cancer Epidemiol Biomarkers Prev 2015; 24:1157-64. [PMID: 25990553 PMCID: PMC5746176 DOI: 10.1158/1055-9965.epi-15-0123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/13/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer-related death among Chinese Americans. A detailed examination of incidence trends by immigration status and histology may inform the etiology of lung cancer in this growing population. METHODS California Cancer Registry data were enhanced with data on patient nativity. Lung cancer incidence rates for Chinese males and females were computed for the years 1990-2010, and rates by immigration status and histology were computed for 1990-2004. Trends were assessed with annual percentage change (APC) statistics (two-sided P values) based on linear regression. RESULTS A total of 8,167 lung cancers were diagnosed among California Chinese from 1990 to 2010. Overall incidence increased nonstatistically among U.S.-born males (APC, 2.1; 95% CI, -4.9 to 9.7), but decreased significantly among foreign-born (APC, -1.7; 95% CI, -2.9 to -0.6). Statistically significant decreasing trends were observed for non-small cell lung cancer (NSCLC), specifically the squamous cell and large cell carcinoma subtypes among foreign-born males. Among females, incidence decreased nonsignificantly among U.S.-born (APC, -2.8; 95% CI, -9.1 to 4.0) but was stable among foreign-born (APC, -0.4; 95% CI, -1.7 to 1.0). A statistically significant decreasing trend was observed for squamous cell among foreign-born females. CONCLUSIONS These data provide critical evidence base to inform screening, research, and public health priorities in this growing population. IMPACT Given the low smoking prevalence among Chinese Americans, especially females, and few known lung cancer risk factors in U.S. never-smoker populations, additional research of etiologic genetic or biologic factors may elucidate knowledge regarding lung cancer diagnosed in never smokers.
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Affiliation(s)
- Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford School of Medicine, Stanford, California. Stanford Cancer Institute, Palo Alto, California.
| | - Juan Yang
- Cancer Prevention Institute of California, Fremont, California
| | | | | | | | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Palo Alto, California
| | | | - Manali Patel
- Stanford Cancer Institute, Palo Alto, California
| | - Christina A Clarke
- Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford School of Medicine, Stanford, California. Stanford Cancer Institute, Palo Alto, California
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Tao L, Ladabaum U, Gomez SL, Cheng I. Colorectal cancer mortality among Hispanics in California: differences by neighborhood socioeconomic status and nativity. Cancer 2014; 120:3510-8. [PMID: 25042119 PMCID: PMC5736794 DOI: 10.1002/cncr.28837] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 04/11/2014] [Accepted: 05/12/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Socioeconomic status (SES) plays an important role in colorectal cancer (CRC) mortality, although the independent and joint effects with nativity and neighborhood factors have yet to be evaluated. METHODS With nearly one-third of all US Hispanics residing in California, the authors obtained information from the California Cancer Registry to examine the associations between neighborhood SES and mortality in all 33,146 Hispanic individuals diagnosed with CRC from 1988 through 2010, with a particular focus on associations among US-born and foreign-born Hispanics. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CI) for overall and CRC-specific mortality. RESULTS Hispanics residing in lower SES neighborhoods demonstrated a higher rate of overall and CRC-specific mortality than those residing in high SES neighborhoods (SES quintile 1[low] vs quintile 5 [high]: HR, 1.15 [95% CI, 1.05-1.26] and HR, 1.16 [95% CI, 1.03-1.30], respectively). Nativity modified the associations between SES and mortality (P for interaction, .02 for overall and P for interaction, .01 for CRC-specific mortality) such that the SES associations were observed only among US-born (P for trend < .01 for overall and CRC-specific mortality) but not among foreign-born Hispanics. CONCLUSIONS Neighborhood SES demonstrates significant differential effects on overall and CRC-specific mortality between US-born and foreign-born Hispanics. Future efforts should investigate the underlying contextual and individual-level factors that could account for these differential associations by nativity.
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Affiliation(s)
- Li Tao
- Cancer Prevention Institute of California, Fremont, California
| | - Uri Ladabaum
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Iona Cheng
- Cancer Prevention Institute of California, Fremont, California
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Cheng I, Le GM, Noone AM, Gali K, Patel M, Haile RW, Wakelee HA, Gomez SL. Lung cancer incidence trends by histology type among Asian American, Native Hawaiian, and Pacific Islander populations in the United States, 1990-2010. Cancer Epidemiol Biomarkers Prev 2014; 23:2250-65. [PMID: 25368400 PMCID: PMC5738466 DOI: 10.1158/1055-9965.epi-14-0493] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Lung cancer is one of the leading cancer sites diagnosed among Asian Americans, Pacific Islanders, and Native Hawaiians (AANHPI). To better understand the patterns of lung cancer incidence among AANHPIs, we examined the incidence trends of five histologic cell types of lung cancer across ten AANHPI populations in comparison with non-Hispanic Whites. METHODS Lung cancer incidence data from 1990 through 2010 were obtained from 13 U.S. population-based cancer registries. Age-adjusted histologic cell-type-specific incidence rates and 95% confidence intervals were calculated. Joinpoint regression models and annual percentage change (APC) statistics were used to characterize the magnitude and direction of trends. RESULTS From 1990 through 2010, incidence rates of adenocarcinoma increased significantly for Filipino and Korean women with a 2.6% and 3.0% annual percentage increase, respectively. More recently, a significant rise in the incidence of adenocarcinoma was observed for Chinese men (1996-2010; APC = 1.3%). Squamous cell carcinoma (SCC) increased 2.4% per year among Japanese women. For SCC, small cell lung carcinoma, large cell and other specified carcinoma, and unspecified types, stable or decreasing trends were observed in most AANHPI groups and non-Hispanic Whites. CONCLUSIONS AANHPIs demonstrate a range in the burden of lung cancer across histologies and specific populations. IMPACT These findings illustrate the importance of disaggregating AANHPIs into their specific populations. The rise in incidence of adenocarcinoma and SCC among certain AANHPIs demonstrates the need for research into non-tobacco associated risk factors for these populations and targeted efforts for tobacco prevention.
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Affiliation(s)
- Iona Cheng
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California.
| | - Gem M Le
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
| | - Anne-Michelle Noone
- Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Kathleen Gali
- Social Cognitive Sciences Graduate Group, School of Social Sciences Humanities and Arts, University of California, Merced, California
| | - Manali Patel
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California. Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert W Haile
- Stanford Cancer Institute, Stanford, California. Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Heather A Wakelee
- Stanford Cancer Institute, Stanford, California. Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Scarlett L Gomez
- Cancer Prevention Institute of California, Fremont, California. Stanford Cancer Institute, Stanford, California. Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
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Berry C, Kaplan SA, Mijanovich T, Mayer A. Moving to patient reported collection of race and ethnicity data: implementation and impact in ten hospitals. Int J Health Care Qual Assur 2014; 27:271-83. [PMID: 25076602 DOI: 10.1108/ijhcqa-05-2012-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to examine the feasibility of collecting standardized, patient reported race and ethnicity (RE) data in hospitals, and to assess the impact on data quality and utility. DESIGN/METHODOLOGY/APPROACH Part of a larger evaluation that included a comprehensive assessment. Sites documented RE data collection procedures before and after program implementation. Primary data collected through qualitative interviewing with key respondents in ten hospitals to assess implementation. Nine hospitals provided RE data on the same patients before and after implementation new data collection procedures were implemented to assess impact. FINDINGS Implementation went smoothly in nine of ten hospitals and had substantial effects on the hospital staff awareness on the potential for disparities within their hospitals. New procedures had minimal impact on characterization of readmitted patients. PRACTICAL IMPLICATIONS This study demonstrated that it is feasible for staff in a diverse group of hospitals to implement systematic, internally standardized methods to collect self-reported RE data from patients. ORIGINALITY/VALUE Although this study found little impact patients' demographic characterizations, other benefits included greater awareness of and attention to disparities, uncovering small pockets of minorities, and dramatically increased RE data use in quality improvement efforts.
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Schupp CW, Press DJ, Gomez SL. Immigration factors and prostate cancer survival among Hispanic men in California: does neighborhood matter? Cancer 2014; 120:1401-8. [PMID: 24477988 PMCID: PMC5739913 DOI: 10.1002/cncr.28587] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/20/2013] [Accepted: 12/23/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Hispanics are more likely than other racial/ethnic groups in the United States to be diagnosed with later stage of prostate cancer, yet they have lower prostate cancer mortality rates. The authors evaluated the impact of nativity and neighborhood-level Hispanic ethnic enclave on prostate cancer survival among Hispanics. METHODS A total of 35,427 Hispanic men diagnosed with invasive prostate cancer from 1995 through 2008 in the California Cancer Registry were studied; vital status data were available through 2010. Block group-level neighborhood measures were developed from US Census data. Stage-stratified Cox proportional hazards models were used to assess the effect of nativity and ethnic enclave on prostate cancer survival. RESULTS In models adjusted for neighborhood socioeconomic status and other individual factors, foreign-born Hispanics were found to have a significantly lower risk of prostate cancer survival (hazards ratio [HR], 0.81; 95% confidence interval [95% CI], 0.75-0.87). Living in an ethnic enclave appeared to modify this effect, with the survival advantage slightly more pronounced in the high ethnic enclave neighborhoods (HR, 0.78; 95% CI, 0.71-0.86) compared with low ethnic enclave neighborhoods (HR, 0.86; 95% CI, 0.76-0.98). CONCLUSIONS Despite lower socioeconomic status, Hispanic immigrants have better survival after prostate cancer than US-born Hispanics and this pattern was more striking among those living in ethnic enclaves. Identifying the modifiable individual and neighborhood-level factors that facilitate this survival advantage in Hispanic immigrants may help to inform specific interventions to improve survival among all patients.
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Banegas MP, Tao L, Altekruse S, Anderson WF, John EM, Clarke CA, Gomez SL. Heterogeneity of breast cancer subtypes and survival among Hispanic women with invasive breast cancer in California. Breast Cancer Res Treat 2014; 144:625-34. [PMID: 24658879 PMCID: PMC4045012 DOI: 10.1007/s10549-014-2882-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 02/11/2014] [Indexed: 01/07/2023]
Abstract
There are limited data regarding breast cancer subtypes among Hispanic women. The current study assessed the distribution and prognosis of molecular subtypes defined by joint expression of the hormone receptors (HR; estrogen and progesterone) and human epidermal growth factor receptor 2 (HER2). Using California Cancer Registry data, we identified Hispanic women diagnosed with invasive breast cancer from 2005 to 2010. Breast cancer subtypes were defined as HR+/HER2-, HR+/HER2+, HR-/HER2+, and HR-/HER2- (triple negative). We estimated breast cancer subtype frequencies and used polytomous logistic regression, Kaplan-Meier survival plots and Cox regression to examine differences in relation to demographic and clinical characteristics. Among 16,380 Hispanic women with breast cancer, HR+/HER- subtype was the most common (63 %), followed by triple negative (16 %), HR+/HER2+ (14 %), and HR-/HER2+ (8 %). Women in lower SES neighborhoods had greater risk of triple negative and HR-/HER2+ subtypes relative to HR+/HER2- (p < 0.05). Hispanic women with triple negative and HR-/HER2+ tumors experienced poorer survival than those with HR+/HER- tumors. Breast cancer-specific mortality increased with decreasing SES, relative to the highest SES quintile, from HR = 1.38 for quintile 4 to HR = 1.76 for quintile 1 (lowest SES level). Our findings indicate that Hispanic women residing in low SES neighborhoods had significantly increased risk of developing and dying from HR- than HR+ breast cancers. Similar patterns of subtype frequency and prognosis among California Hispanic women and studies of other racial/ethnic groups underscore the need to better understand the impact of SES on risk factor exposures that increase the risk of breast cancer subtypes with poor prognosis.
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Affiliation(s)
- Matthew P Banegas
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Drive, MSC 9762, Bethesda, MD, 20892-9762, USA,
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Creswell PD, Strickland R, Stephenson L, Pierce-Hudson K, Matloub J, Waukau J, Adams A, Kaur J, Remington PL. Look local: the value of cancer surveillance and reporting by American Indian clinics. Prev Chronic Dis 2013; 10:E197. [PMID: 24286271 PMCID: PMC3843605 DOI: 10.5888/pcd10.130153] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction Cancer incidence and mortality rates for American Indians in the Northern Plains region of the United States are among the highest in the nation. Reliable cancer surveillance data are essential to help reduce this burden; however, racial data in state cancer registries are often misclassified, and cases are often underreported. Methods We used a community-based participatory research approach to conduct a retrospective ascertainment of cancer cases in clinic medical records over a 9-year period (1995–2003) and compared the results with the state cancer registry to evaluate missing or racially misclassified cases. Six tribal and/or urban Indian clinics participated in the study. The project team consisted of participating clinics, a state cancer registry, a comprehensive cancer center, an American Indian/Alaska Native Leadership Initiative on Cancer, and a set of diverse organizational partners. Clinic personnel were trained by project staff to accurately identify cancer cases in clinic records. These records were then matched with the state cancer registry to assess misclassification and underreporting. Results Forty American Indian cases were identified that were either missing or misclassified in the state registry. Adding these cases to the registry increased the number of American Indian cases by 21.3% during the study period (P = .05). Conclusions Our results indicate that direct reporting of cancer cases by tribal and urban Indian health clinics to a state cancer registry improved the quality of the data available for cancer surveillance. Higher-quality data can advance the efforts of cancer prevention and control stakeholders to address disparities in Native communities.
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Affiliation(s)
- Paul D Creswell
- University of Wisconsin Department of Population Health Sciences, Madison, Wisconsin
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Gomez SL, Noone AM, Lichtensztajn DY, Scoppa S, Gibson JT, Liu L, Morris C, Kwong S, Fish K, Wilkens LR, Goodman MT, Deapen D, Miller BA. Cancer incidence trends among Asian American populations in the United States, 1990-2008. J Natl Cancer Inst 2013; 105:1096-110. [PMID: 23878350 PMCID: PMC3735462 DOI: 10.1093/jnci/djt157] [Citation(s) in RCA: 215] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 04/17/2013] [Accepted: 04/18/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND National cancer incidence trends are presented for eight Asian American groups: Asian Indians/Pakistanis, Chinese, Filipinos, Japanese, Kampucheans, Koreans, Laotians, and Vietnamese. METHODS Cancer incidence data from 1990 through 2008 were obtained from 13 Surveillance, Epidemiology, End Results (SEER) registries. Incidence rates from 1990 through 2008 and average percentage change were computed using SEER*Stat and Joinpoint software. The annual percentage change (APC) in incidence rates was estimated with 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. Rates for non-Hispanic whites are presented for comparison. RESULTS Prostate cancer was the most common malignancy among most groups, followed by lung, colorectal, liver, and stomach cancers. Breast cancer was generally the most common cancer in women, followed by colorectal and lung cancers; liver, cervix, thyroid, and stomach cancers also ranked highly. Among men, increasing trends were observed for prostate (Asian Indians and Pakistanis: APC 1990-2003 = 2.2, 95% CI = 0.3 to 4.1; Filipinos: APC 1990-1994 = 19.0, 95% CI = 4.5 to 35.4; Koreans: APC 1990-2008 = 2.9, 95% CI = 1.8 to 4.0), colorectal (Koreans: APC 1990-2008 = 2.2, 95% CI = 0.9 to 3.5), and liver cancers (Filipinos: APC 1990-2008 = 1.6, 95% CI = 0.4 to 2.7; Koreans: APC 1990-2006 = 2.1, 95% CI = 0.4 to 3.7; Vietnamese: APC 1990-2008 = 1.6, 95% CI = 0.3 to 2.8), whereas lung and stomach cancers generally remained stable or decreased. Among women, increases were observed for uterine cancer (Asian Indians: APC 1990-2008 = 3.0, 95% CI = 0.3 to 5.8; Chinese: APC 2004-2008 = 7.0, 95% CI = 1.4 to 12.9; Filipina: APC 1990-2008 = 3.0, 95% CI = 2.4 to 3.7; Japanese: APC 1990-2008 = 1.1, 95% CI = 0.1 to 2.0), colorectal cancer (Koreans: APC 1990-2008 = 2.8, 95% CI = 1.7 to 3.9; Laotians: APC: 1990-2008 = 5.9, 95% CI = 4.0 to 7.7), lung cancer (Filipinas: APC 1990-2008 = 2.1, 95% CI = 1.4 to 2.8; Koreans: APC 1990-2008 = 2.1, 95% CI = 0.6 to 3.6), thyroid cancer (Filipinas: APC 1990-2008 = 2.5, 95% CI = 1.7 to 3.3), and breast cancer in most groups (APC 1990-2008 from 1.2 among Vietnamese and Chinese to 4.7 among Koreans). Decreases were observed for stomach (Chinese and Japanese), colorectal (Chinese), and cervical cancers (Laotians and Vietnamese). CONCLUSIONS These data fill a critical knowledge gap concerning the cancer experience of Asian American groups and highlight where increased preventive, screening, and surveillance efforts are needed-in particular, lung cancer among Filipina and Korean women and Asian Indian/Pakistani men, breast cancer among all women, and liver cancer among Vietnamese, Laotian, and Kampuchean women and Filipino, Kampuchean, and Vietnamese men.
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Liu L, Noone AM, Gomez SL, Scoppa S, Gibson JT, Lichtensztajn D, Fish K, Wilkens LR, Goodman MT, Morris C, Kwong S, Deapen D, Miller BA. Cancer incidence trends among native Hawaiians and other Pacific Islanders in the United States, 1990-2008. J Natl Cancer Inst 2013; 105:1086-95. [PMID: 23878354 PMCID: PMC3735461 DOI: 10.1093/jnci/djt156] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Lack of annual population estimates for disaggregated Native Hawaiian and Other Pacific Islander (NHOPI) populations limits the ability to examine cancer incidence rates and trends to understand the cancer burdens among NHOPIs. METHODS Utilizing 1990 and 2000 population census data, we estimated the annual populations by age and sex for Native Hawaiians, Samoans, and Guamanians/Chamorros for 1990-2008 in regions covered by 13 of the National Cancer Institute's SEER registries. Cancer diagnoses during 1990-2008 from these registries were used to calculate the age-adjusted (2000 US Standard) incidence rates by sex, calendar year/period, and cancer type for each population. The annual percentage change (APC) in incidence rates was estimated with the 95% confidence intervals (95% CIs) calculated for both the rate and APC estimates. RESULTS Statistically significant declining trends were found in Native Hawaiians, in men for lung and stomach cancers (APC = -2.3%; 95% CI = -3.3 to -1.3; and APC = -3.8%; 95% CI = -6.0 to -1.6, respectively), and in women for breast cancer (APC = -4.1%; 95% CI = -5.7 to -2.5) since 1998 and lung cancer (APC = -6.4%; 95% CI = -10.7 to -1.8) since 2001. Rising incidence trends were experienced by Samoans, especially by Samoan women for breast (APC = 2.7%; 95% CI = 0.9 to 4.5) and uterus (APC = 7.3%; 95% CI = 6.2 to 8.4) cancers. With limited data, Guamanians/Chamorros demonstrated lower, but increasing, incidence rates than other NHOPIs. CONCLUSIONS Population-based cancer incidence rates for disaggregated NHOPI populations help identify disparities in cancer burden and provide valuable information to improve cancer control efforts among NHOPIs.
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Affiliation(s)
- Lihua Liu
- Los Angeles Cancer Surveillance Program, University of Southern California, Los Angeles, CA 90089-9238, USA.
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Sieh W, Lichtensztajn DY, Nelson DO, Cockburn M, West DW, Brooks JD, Chang ET. Treatment and Mortality in Men with Localized Prostate Cancer: A Population-Based Study in California. THE OPEN PROSTATE CANCER JOURNAL 2013; 6:1-9. [PMID: 23997838 PMCID: PMC3758138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE To provide patients and physicians with population-based estimates of mortality from prostate cancer or other causes depending upon the primary treatment modality, stratified by patient age, tumor stage and grade. METHODS We conducted a 10-year competing-risk analysis of 45,440 men diagnosed with clinically localized (T1 or T2) prostate cancer in California during 1995-1998. Information on patient characteristics, primary treatment and cause of death was obtained from the California Cancer Registry. RESULTS In this population-based cohort, the most common primary treatment was surgery (40.4%), followed by radiotherapy (29.1%), conservative management (20.8%), and androgen deprivation therapy (ADT) monotherapy (9.8%). Prostate cancer mortality differed significantly (p < 0.0001) across treatment groups among patients <80 years at diagnosis with moderately or poorly differentiated disease; the 10-year disease-specific mortality rates were generally highest for men treated with ADT monotherapy [range: 3.3% (95% CI=0.8-12.5%) to 53.8% (95% CI=34.4-72.2%)], intermediate for men treated with conservative management [range: 1.7% (95% CI=0.7-4.6%) to 30.0% (95% CI=16.2-48.8%] or radiotherapy [range: 3.2% (95% CI=1.8-5.5%) to 18.3% (95% CI=15.1-22.0%)], and lowest for men treated with surgery [range: 1.2% (95% CI=0.8-1.7%) to 11.0% (95% CI=8.4-14.2%)]. CONCLUSION The cause-specific mortality estimates provided by this observational study can help patients and physicians better understand the expected long-term outcomes of localized prostate cancer given the initial treatment choice and practice patterns in the general population.
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Affiliation(s)
- Weiva Sieh
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | | | | | - Myles Cockburn
- Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles, CA
| | - Dee W. West
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
- Cancer Prevention Institute of California, Fremont, CA
| | - James D. Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, CA
| | - Ellen T. Chang
- Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
- Cancer Prevention Institute of California, Fremont, CA
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Sanders CM, Saltzstein SL, Schultzel MM, Nguyen DH, Stafford HS, Sadler GR. Understanding the limits of large datasets. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2012; 27:664-669. [PMID: 22729362 PMCID: PMC4153382 DOI: 10.1007/s13187-012-0383-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Many health professionals use large datasets to answer behavioral, translational, or clinical questions. Understanding the impact of missing data in large databases, such as disease registries, can avoid erroneous interpretations of these data. Using the California Cancer Registry, the authors selected seven common cancers, seven sociodemographic and clinical variables, and the top three reporting sources, as examples of the type of data that would be deemed critical to most studies. The gender variable had no missing data, followed by age (<0.1 % missing), ethnicity (1.7 %), stage (9.8 %), differentiation (39.1 %), and birthplace (41.1 %). Reports from hospitals and clinics had the lowest percentages of missing data. Users of large datasets should anticipate the limitations of missing data to prevent methodological flaws and misinterpretations of research findings. Knowledge of what and how much data may be missing in large datasets can help prevent errors in research conclusions, while better guiding treatment modalities and public health policies and programs.
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Affiliation(s)
- Catherine M Sanders
- Rebecca and John Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA 92093-0850, USA.
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Clarke CA, Keegan THM, Yang J, Press DJ, Kurian AW, Patel AH, Lacey JV. Age-specific incidence of breast cancer subtypes: understanding the black-white crossover. J Natl Cancer Inst 2012; 104:1094-101. [PMID: 22773826 DOI: 10.1093/jnci/djs264] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Breast cancer incidence is higher among black women than white women before age 40 years, but higher among white women than black women after age 40 years (black-white crossover). We used newly available population-based data to examine whether the age-specific incidences of breast cancer subtypes vary by race and ethnicity. METHODS We classified 91908 invasive breast cancers diagnosed in California between January 1, 2006, and December 31, 2009, by subtype based on tumor expression of estrogen receptor (ER) and progesterone receptor (PR)-together referred to as hormone receptor (HR)-and human epidermal growth factor receptor 2 (HER2). Breast cancer subtypes were classified as ER or PR positive and HER2 negative (HR(+)/HER2(-)), ER or PR positive and HER2 positive (HR(+)/HER2(+)), ER and PR negative and HER2 positive (HR(-)/HER2(+)), and ER, PR, and HER2 negative (triple-negative). We calculated and compared age-specific incidence rates, incidence rate ratios, and 95% confidence intervals by subtype and race (black, white, Hispanic, and Asian). All P values are two-sided. RESULTS We did not observe an age-related black-white crossover in incidence for any molecular subtype of breast cancer. Compared with white women, black women had statistically significantly higher rates of triple-negative breast cancer at all ages but statistically significantly lower rates of HR(+)/HER2(-) breast cancers after age 35 years (all P < .05). The age-specific incidence of HR(+)/HER2(+) and HR(-)/HER2(+) subtypes did not vary markedly between white and black women. CONCLUSIONS The black-white crossover in breast cancer incidence occurs only when all breast cancer subtypes are combined and relates largely to higher rates of triple-negative breast cancers and lower rates of HR(+)/HER2(-) breast cancers in black vs white women.
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Affiliation(s)
- Christina A Clarke
- Research Scientist, Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538-2334, USA.
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Ai WZ, Chang ET, Fish K, Fu K, Weisenburger DD, Keegan THM. Racial patterns of extranodal natural killer/T-cell lymphoma, nasal type, in California: a population-based study. Br J Haematol 2011; 156:626-32. [PMID: 22188140 DOI: 10.1111/j.1365-2141.2011.08982.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In order to investigate whether the clinical behaviour of extranodal natural killer/T-cell lymphoma, nasal type (ENKTL) varies by race within a geographic region, we identified a total of 213 non-Hispanic whites, Hispanics and Asians/Pacific islanders (APIs) diagnosed with ENKTL in the California Cancer Registry between 2001 and 2008. The incidence and outcomes of the disease in these racial groups were analysed. The incidence rates in non-Hispanic whites, Hispanics and APIs were 0.05, 0.18 and 0.23 per 100,000 person-years, respectively, among males; and 0.03, 0.07 and 0.10 per 100,000 person-years, respectively, among females. The overall survival (OS) at 5 years was 28.6% in non-Hispanic whites, 30.4% in Hispanic, and 24.0% in APIs. In multivariate analysis, distant versus local/regional disease (Hazard Ratio [HR]=2.01, 95% confidence interval [CI]: 1.36, 2.96), initial treatment with chemotherapy plus radiotherapy (HR=0.39, 95% CI: 0.22, 0.70) or radiotherapy alone (HR=0.48, 95% CI: 0.23, 0.99) versus no therapy were associated with OS. However, OS was not affected by age, sex, race, chemotherapy alone, socioeconomic status, or human immunodeficiency virus infection. In conclusion, ENKTL is more common and clinically more similar among Hispanics and APIs than non-Hispanic whites with poor outcome in all racial groups.
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Affiliation(s)
- Weiyun Z Ai
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
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Hashiguchi Y, Hase K, Ueno H, Shinto E, Naito Y, Kajiwara Y, Kuroda T, Yamamoto J, Mochizuki H. Impact of race/ethnicity on prognosis in patients who underwent surgery for colon cancer: analysis for white, African, and East Asian Americans. Ann Surg Oncol 2011; 19:1517-28. [PMID: 22012028 DOI: 10.1245/s10434-011-2113-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Indexed: 01/07/2023]
Abstract
PURPOSE We retrospectively investigated the impact of race/ethnicity on prognosis in patients who underwent surgery for colon cancer. METHODS Surveillance, Epidemiology, and End Results population-based data on 39,210 colon cancer patients without distant metastasis who underwent radical surgery were analyzed. Prognostic impact of race/ethnicity for non-Hispanic white, Hispanic white, African American, and East Asian (Japanese, Chinese, Korean) American patients, and confounding factors of age, sex, registry region, year of diagnosis, tumor, node, metastasis system stage, tumor grade, tumor site, and the number of lymph nodes examined were analyzed by the Cox proportional hazard model. The lymph node count was analyzed and adjusted means were calculated by a generalized multiple regression model with respect to race and other factors. RESULTS Significant differences due to race/ethnicity were observed in crude hazard ratios with respect to overall and colon cancer-specific mortality, which persisted even after adjusting for confounding factors. Adjusted hazard ratios of colon cancer-specific mortality for non-Hispanic white, Hispanic white, African American, and East Asian American patients were 1 (reference), 1.01 (95% confidence interval 0.91-1.12), 1.40 (95% confidence interval 1.31-1.50), and 0.83 (95% confidence interval 0.74-0.94), respectively. There were significant differences in crude number of lymph nodes examined among races, which were no longer significant after adjusting for covariates. CONCLUSIONS East Asian American patients had significantly better prognosis, while African American patients had worse prognosis than non-Hispanic white patients, despite the identical adjusted number of lymph nodes examined after surgery for colon cancer. This disparity in prognosis among races/ethnicities should be taken into consideration when deciding adjuvant chemotherapy for nonwhite patients.
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Affiliation(s)
- Yojiro Hashiguchi
- Department of Surgery, National Defense Medical College, Saitama, Japan.
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Kurian AW, Fish K, Shema SJ, Clarke CA. Lifetime risks of specific breast cancer subtypes among women in four racial/ethnic groups. Breast Cancer Res 2010; 12:R99. [PMID: 21092082 PMCID: PMC3046442 DOI: 10.1186/bcr2780] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 11/09/2010] [Accepted: 11/19/2010] [Indexed: 02/13/2023] Open
Abstract
INTRODUCTION Breast cancer comprises clinically distinct subtypes, but most risk statistics consider breast cancer only as a single entity. To estimate subtype-specific lifetime breast cancer risks, we took advantage of population-based data for which information regarding tumor expression of estrogen receptor (ER), progesterone receptor (PR) and HER2/neu (HER2) was newly available. METHODS We included women whose breast cancer was diagnosed in the state of California from 2006 to 2007 and was reported to the National Cancer Institute's Surveillance, Epidemiology and End Results Program (N = 40,936). We calculated absolute lifetime and age-specific probabilities (percent, 95% confidence interval) of developing breast cancer subtypes defined by ER, PR, and HER2 status - luminal (ER and/or PR-positive, HER2-negative), HER2-positive (ER and PR-positive or negative, HER2-positive), and triple-negative (ER-negative, PR-negative, and HER2-negative) - separately for white, black, Hispanic, and Asian women. RESULTS The luminal breast cancer subtype predominates across racial/ethnic groups, with lifetime risk lowest in Hispanic women (4.60%, 4.41-4.80%) and highest in white women (8.10%, 7.94-8.20%). HER2-positive breast cancer varies less by race (1.56-1.91%). Lifetime risk of triple-negative breast cancer is highest in black women (1.98%, 1.80-2.17%), compared to 0.77% (0.67-0.88%) for Asians, 1.04% (0.96-1.13%) for Hispanics and 1.25% (1.20-1.30%) for whites. Across racial/ethnic groups, nearly half of all luminal breast cancers occur after age 70. CONCLUSIONS These absolute risk estimates may inform health policy and resource planning across diverse populations, and can help patients and physicians weigh the probabilities of developing specific breast cancer subtypes against competing health risks.
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Affiliation(s)
- Allison W Kurian
- Department of Medicine, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
- Department of Health Research and Policy, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
| | - Kari Fish
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
| | - Sarah J Shema
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
| | - Christina A Clarke
- Department of Health Research and Policy, Stanford University School of Medicine, 259 Campus Drive, Stanford, CA 94305-5405, USA
- Cancer Prevention Institute of California, 2201 Walnut Avenue, Suite 300, Fremont, CA 94538, USA
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Chu KP, Shema S, Wu S, Gomez SL, Chang ET, Le QT. Head and neck cancer-specific survival based on socioeconomic status in Asians and Pacific Islanders. Cancer 2010; 117:1935-45. [PMID: 21509771 DOI: 10.1002/cncr.25723] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 09/13/2010] [Accepted: 09/13/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lower socioeconomic status (SES) has been linked to higher incidence of head and neck cancer (HNC) and lower survival. However, little is known about the effect of SES on HNC survival in Asians and Pacific Islanders (APIs). This study's purpose was to examine the effect of SES on disease-specific survival (DSS) and overall survival (OS) in APIs with HNC using population-based data. METHODS A total of 53,544 HNC patients (4,711 = APIs) were identified from the California Cancer Registry from 1988 to 2007. Neighborhood (block-group-level) SES, based on composite Census 1990 and 2000 data, was calculated for each patient based on address at diagnosis, categorized into statewide quintiles, and collapsed into 2 groups for comparison (low SES = quintiles 1-3; high SES = quintiles 4-5). DSS and OS were computed by the Kaplan-Meier method. Adjusted hazards ratios (HR) were estimated using Cox proportional hazards regression models. RESULTS Among APIs, lower neighborhood SES was significantly associated with poorer DSS (HR range for oral cavity, oropharynx, or larynx/hypopharynx cancer, 1.07-1.34) and OS (HR, 1.13-1.37) after adjusting for patient and tumor characteristics. Lower SES was significantly associated with poorer survival in API with all HNC sites combined: DSS HR: 1.26 (95% confidence interval [CI], 1.08-1.48) and OS HR, 1.30 (95% CI, 1.16-1.45). CONCLUSIONS Neighborhood SES was associated with longer DSS and OS in API with HNC. The effect of SES on HNC survival should be considered in future studies, and particular attention should be paid to clinical care of lower-SES HNC patients.
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Affiliation(s)
- Karen P Chu
- Stanford University Medical Center, Stanford, California 94305-5847, USA
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