Disparities in Stage at Diagnosis in an Equal-access Integrated Delivery System: A Retrospective Cohort Study of 7244 Patients With Bladder Cancer
| Autor: | Aniket A. Kawatkar, Ronald K. Loo, Margo A. Sidell, David K Yi, Kim N. Danforth, Ayae Yamamoto, Stephen G. Williams, Tiffany Q. Luong, Philip H. Kim |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Urology Urinary Bladder 030232 urology & nephrology Ethnic group California White People 03 medical and health sciences 0302 clinical medicine Sex Factors Internal medicine Health care medicine Humans Aged Neoplasm Staging Retrospective Studies Aged 80 and over Bladder cancer business.industry Delivery of Health Care Integrated Age Factors Retrospective cohort study Odds ratio Health Status Disparities Hispanic or Latino Middle Aged medicine.disease Random effects model Confidence interval Health equity Black or African American Oncology Urinary Bladder Neoplasms 030220 oncology & carcinogenesis Female business |
| Zdroj: | Clinical genitourinary cancer. 18(2) |
| ISSN: | 1938-0682 |
| Popis: | Disparities in bladder cancer survival by race/ethnicity and gender are likely related to differences in diagnosis. We assessed disparities in stage at diagnosis and potential contributing factors within a large, integrated delivery system.We conducted a retrospective cohort study of 7244 patients with bladder cancer age ≥ 21 years diagnosed from January 2001 to June 2015 within Kaiser Permanente Southern California. Bivariate analyses compared stage at diagnosis - as well as comorbidities, health plan membership length, and health care utilization prior to diagnosis - by race/ethnicity, gender, and age. Multivariable generalized linear mixed models with urologist as a random effect were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for diagnosis of muscle-invasive bladder cancer (MIBC) versus non-muscle-invasive bladder cancer.In multivariable analyses, stage at diagnosis varied significantly by race/ethnicity (P .001). Non-Hispanic black patients had significantly higher odds of being diagnosed with MIBC than non-Hispanic white patients (OR, 1.33; 95% CI, 1.05-1.67), whereas Asian patients had significantly lower odds (OR, 0.67; 95% CI, 0.49-0.91). Women were significantly more likely to be diagnosed with MIBC than men (OR, 1.40; 95% CI, 1.22-1.61). Non-Hispanic black women had the highest proportion (39%) of MIBC diagnoses. Among Hispanic and Asian patients, a greater proportion of diagnoses occurred at younger ages.Health care coverage within an equal-access system did not eliminate disparities in stage at diagnosis by race/ethnicity or gender. Studies are needed to identify etiologic factors and aspects of care delivery (eg, patient-physician interactions) that may affect the diagnostic process to inform efforts to improve health equity. |
| Databáze: | OpenAIRE |
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