Survival of blacks and whites after a cancer diagnosis.

摘要: ContextIn recent years a theory that cancer biology is different in blacks and whites has gained prominence reaction to epidemiologic observations that blacks have poorer survival than whites, even when diagnosed with cancer of similar severity. Yet, few studies evaluated whether lower-quality treatment and shorter overall life expectancy due greater burden of other illnesses may explain the discrepancy.ObjectiveTo estimate magnitude cancer-specific differences between who receive comparable treatment for similar-stage cancer.Data SourcesWe searched MEDLINE English-language articles published from 1966 to January 2002 reported on black white patients treated similarly cancer.Study SelectionThe abstracts or titles 891 citations were independently examined by 2 authors. The full text was retrieved if abstract mentioned both black and patients, made some comment regarding either similarity treatment received presented an analysis based received, commented on survival. Studies included they data at least 10 patients; specified cohort ascertainment method what measures undertaken minimize loss follow-up; summarized survival of using actuarial measures; outcomes within stage, adjusted stage, cohorts balanced stage distributions; and study received treatment. We identified 89 unique 54 met our inclusion criteria.Data ExtractionOverall rates hazard ratios (HRs) death blacks relative calculated. These subsequently rates of causes other under determine cancer-specific survival HRs.Data SynthesisResults represent 189 877 32 004 patients with 14 cancers. Compared had excess risk (HR, 1.16; 95% confidence interval [CI], 1.12-1.20). After correction for deaths causes, HR 1.07 (95% CI, 1.02-1.13). Of cancers, significantly higher risk cancer-specific death only breast, uterus, bladder.ConclusionsOnly modest differences are evident treated comparably similar-stage cancer. Therefore, differences in between racial groups unlikely be responsible for a substantial portion discrepancy. Differences treatment, stage presentation, mortality diseases should represent the primary targets research interventions designed reduce disparities in outcomes.