Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Patients with Cancer Who Refuse Recommended Radiation Therapy or Surgery
Abstract
:Simple Summary
Abstract
1. Introduction
1.1. Treatment Refusal for Cancer
1.2. AA and NHPI Data Disaggregation
2. Materials and Methods
2.1. Study Design and Patient Demographics
2.2. Variables
2.3. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Overall Mortality Due to Treatment Refusal
3.3. Risk and Predictors of RT and Surgery Refusal
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Radiation Recommended n = 60,117 | Surgery Recommended n = 129,276 |
---|---|---|
Follow-Up, Months, median (IQR) | 62 (35–99) | 60 (34–96) |
Deceased | 9888 (16%) | 19,062 (15%) |
Sex | ||
Male | 14,623 (24%) | 34,320 (27%) |
Female | 45,494 (76%) | 94,956 (73%) |
Stage | ||
Late | 11,895 (20%) | 20,000 (15%) |
Early | 48,222 (80%) | 109,276 (85%) |
Age, Years, median (IQR) | 59 (49–69) | 59 (49–69) |
Cancer Type | ||
Lung | 4261 (7.1%) | 7157 (5.5%) |
Breast | 35,318 (59%) | 60,702 (47%) |
Colorectal | 3547 (5.9%) | 18,417 (14%) |
Endometrial | 2404 (4.0%) | 8380 (6.5%) |
Kidney/Bladder | 285 (0.5%) | 10,205 (7.9%) |
Melanoma | 27 (<0.1%) | 948 (0.7%) |
Oral Cavity | 606 (1.0%) | 1688 (1.3%) |
Pancreas | 721 (1.2%) | 1578 (1.2%) |
Prostate | 7625 (13%) | 9368 (7.2%) |
Thyroid | 5323 (8.9%) | 10,833 (8.4%) |
Income | ||
Higher Income | 9368 (16%) | 21,471 (17%) |
Lower Income | 46,181 (77%) | 97,898 (76%) |
Missing | 4568 (7.6%) | 9907 (7.7%) |
Rurality | ||
Metropolitan | 57,279 (95%) | 122,763 (95%) |
Urban–Rural | 1527 (2.5%) | 3432 (2.7%) |
Missing | 1311 (2.2%) | 3081 (2.4%) |
Education | ||
More Education | 34,246 (57%) | 72,395 (56%) |
Less Education | 21,313 (35%) | 46,990 (36%) |
Missing | 4558 (7.6%) | 9891 (7.7%) |
Insurance Status | ||
Private Insurance | 34,147 (57%) | 71,454 (55%) |
Medicaid/Medicare | 23,477 (39%) | 52,195 (40%) |
Uninsured | 1710 (2.8%) | 3911 (3.0%) |
Missing | 783 (1.3%) | 1716 (1.3%) |
Distance To Hospital, median (IQR) | 7 (3, 12) | 7 (4, 12) |
Missing | 4550 | 9903 |
Comorbidity Index | ||
<2 | 59,652 (99%) | 127,971 (99%) |
3+ | 465 (0.8%) | 1305 (1.0%) |
Facility Type | ||
Academic | 23,700 (39%) | 53,656 (42%) |
Community | 6346 (11%) | 12,864 (10.0%) |
Comp. Community | 19,796 (33%) | 40,895 (32%) |
Integrated | 5376 (8.9%) | 11,855 (9.2%) |
Missing | 4899 (8.1%) | 10,006 (7.7%) |
U.S. Region | ||
Northeast | 11,429 (19%) | 26,553 (21%) |
Midwest | 5495 (9.1%) | 11,864 (9.2%) |
South | 8140 (14%) | 18,042 (14%) |
West | 30,154 (50%) | 62,811 (49%) |
Missing | 4899 (8.1%) | 10,006 (7.7%) |
Year of Diagnosis | ||
2004–2010 | 25,700 (43%) | 52,391 (41%) |
2011–2017 | 34,417 (57%) | 76,885 (59%) |
Treatment | aHR | 95% CI | Forest Plot | p-Value | ||
---|---|---|---|---|---|---|
RT Refusal | <0.001 | |||||
RT Administered | 1.00 | Reference | ||||
RT Refused | 1.17 | (1.08–1.27) | ||||
Surgery Refusal | 0.262 | |||||
Surgery Performed | 1.00 | Reference | ||||
Surgery Refused | 1.07 | (0.95–1.20) | ||||
0.5 | 1 | 2 | ||||
aHR |
Characteristic | n (%) | aOR | 95% CI | Forest Plot | ||
---|---|---|---|---|---|---|
RT Refusal | ||||||
East AA | 1288 (5.2%) | — | — | |||
NHPI | 373 (7.1%) | 1.38 | (1.21–1.57) | |||
South AA | 473 (4.2%) | 0.86 | (0.76–0.97) | |||
Southeast AA | 754 (4.1%) | 0.82 | (0.74–0.91) | |||
Surgery Refusal | ||||||
East AA | 498 (0.9%) | — | — | |||
NHPI | 107 (1.0%) | 1.28 | (1.00–1.61) | |||
South AA | 159 (0.7%) | 0.79 | (0.65–0.97) | |||
Southeast AA | 309 (0.8%) | 0.96 | (0.83–1.13) | |||
0.5 | 1 | 2 | ||||
aOR |
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Lau, B.; Tominez, P.; Shing, J.Z.; Vo, J.B.; Pollom, E.; Taparra, K. Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Patients with Cancer Who Refuse Recommended Radiation Therapy or Surgery. Cancers 2023, 15, 3358. https://doi.org/10.3390/cancers15133358
Lau B, Tominez P, Shing JZ, Vo JB, Pollom E, Taparra K. Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Patients with Cancer Who Refuse Recommended Radiation Therapy or Surgery. Cancers. 2023; 15(13):3358. https://doi.org/10.3390/cancers15133358
Chicago/Turabian StyleLau, Brianna, Paul Tominez, Jaimie Z. Shing, Jacqueline B. Vo, Erqi Pollom, and Kekoa Taparra. 2023. "Racial Disparities among Asian American, Native Hawaiian, and Other Pacific Islander Patients with Cancer Who Refuse Recommended Radiation Therapy or Surgery" Cancers 15, no. 13: 3358. https://doi.org/10.3390/cancers15133358