Jie Lin1, Shelia H Zahm, Craig D Shriver, Mark Purdue, Katherine A McGlynn, Kangmin Zhu. 1. Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 11300 Rockville Pike, Suite 1120, Rockville, MD, 20852, USA, jlin@murthacancercenter.org.
Abstract
PURPOSE: Unequal access to health care may be a reason for shorter survival among Black patients with renal cell carcinoma (RCC) than among their White counterparts. No studies have investigated survival disparity among RCC patients in an equal-access health care delivery system. This study aimed to examine racial differences in survival among clear cell RCC patients in the Department of Defense's (DoD) Military Health System (MHS), which provides equal access to care to all persons. METHODS: The study used the DoD's Automated Central Tumor Registry to identify 2056 White patients and 370 Black patients diagnosed with clear cell RCC between 1988 and 2004. The subjects were followed through 2007 with a median follow-up time of 4.8 years. Kaplan-Meier survival curves were compared and a Cox model was used to estimate the hazard ratios (HRs) associated with survival by race. RESULTS: During follow-up, 1,027 White and 158 Black patients died. The Kaplan-Meier curves showed that Black patients had more favorable overall survival than did White patients (log rank p = 0.031). After adjustment for demographic, tumor, and treatment variables, the Cox model showed no statistically significant racial difference overall (adjusted HR 1.07, 95 % CI 0.90-1.28) or stratified by age, sex or tumor stage. However, among patients who did not undergo surgery, Black patients had poorer survival than White patients. CONCLUSIONS: The lack of racial difference in survival among RCC patients in the MHS may be related to equal access to health care. Improved access could reduce the survival disparity among RCC patients in the general population.
PURPOSE: Unequal access to health care may be a reason for shorter survival among Black patients with renal cell carcinoma (RCC) than among their White counterparts. No studies have investigated survival disparity among RCCpatients in an equal-access health care delivery system. This study aimed to examine racial differences in survival among clear cell RCCpatients in the Department of Defense's (DoD) Military Health System (MHS), which provides equal access to care to all persons. METHODS: The study used the DoD's Automated Central Tumor Registry to identify 2056 White patients and 370 Black patients diagnosed with clear cell RCC between 1988 and 2004. The subjects were followed through 2007 with a median follow-up time of 4.8 years. Kaplan-Meier survival curves were compared and a Cox model was used to estimate the hazard ratios (HRs) associated with survival by race. RESULTS: During follow-up, 1,027 White and 158 Black patients died. The Kaplan-Meier curves showed that Black patients had more favorable overall survival than did White patients (log rank p = 0.031). After adjustment for demographic, tumor, and treatment variables, the Cox model showed no statistically significant racial difference overall (adjusted HR 1.07, 95 % CI 0.90-1.28) or stratified by age, sex or tumor stage. However, among patients who did not undergo surgery, Black patients had poorer survival than White patients. CONCLUSIONS: The lack of racial difference in survival among RCCpatients in the MHS may be related to equal access to health care. Improved access could reduce the survival disparity among RCCpatients in the general population.
Authors: Charles R Mulligan; Amir D Meram; Courtney D Proctor; Hongyu Wu; Kangmin Zhu; Aizen J Marrogi Journal: Cancer Epidemiol Biomarkers Prev Date: 2006-01 Impact factor: 4.254
Authors: R C Bergan; R G Walls; W D Figg; N A Dawson; D Headlee; A Tompkins; S M Steinberg; E Reed Journal: J Natl Med Assoc Date: 1997-09 Impact factor: 1.798
Authors: Jonathan N Hofmann; Kendra Schwartz; Wong-Ho Chow; Julie J Ruterbusch; Brian M Shuch; Sara Karami; Nathaniel Rothman; Sholom Wacholder; Barry I Graubard; Joanne S Colt; Mark P Purdue Journal: Cancer Causes Control Date: 2012-11-21 Impact factor: 2.506
Authors: Abegail A Andaya; Lindsey Enewold; Shelia H Zahm; Craig D Shriver; Alexander Stojadinovic; Katherine A McGlynn; Kangmin Zhu Journal: Cancer Epidemiol Biomarkers Prev Date: 2013-04-10 Impact factor: 4.254
Authors: Deborah R Kaye; Lauren E Wilson; Melissa A Greiner; Lisa P Spees; Jessica E Pritchard; Tian Zhang; Craig E Pollack; Daniel George; Charles D Scales; Chris D Baggett; Cary P Gross; Michael S Leapman; Stephanie B Wheeler; Michaela A Dinan Journal: J Geriatr Oncol Date: 2022-02-04 Impact factor: 3.929
Authors: David J Paulucci; John P Sfakianos; Anders J Skanderup; Kathleen Kan; Che-Kai Tsao; Matthew D Galsky; A Ari Hakimi; Ketan K Badani Journal: Oncotarget Date: 2017-01-17
Authors: Jennifer N Sims; Clement G Yedjou; Daniel Abugri; Marinelle Payton; Timothy Turner; Lucio Miele; Paul B Tchounwou Journal: Int J Environ Res Public Health Date: 2018-05-28 Impact factor: 3.390
Authors: Abiodun Mafolasire; Xiaopan Yao; Cayce Nawaf; Alfredo Suarez-Sarmiento; Wong-Ho Chow; Wei Zhao; Douglas Corley; Jonathan N Hofmann; Mark Purdue; Adebowale J Adeniran; Brian Shuch Journal: Cancer Med Date: 2016-05-26 Impact factor: 4.452
Authors: Ken Batai; Alfredo Harb-De la Rosa; Jiping Zeng; Juan J Chipollini; Francine C Gachupin; Benjamin R Lee Journal: Cancer Med Date: 2019-09-11 Impact factor: 4.452
Authors: Dylan T Wolff; Thomas F Monaghan; Danielle J Gordon; Kyle P Michelson; Tashzna Jones; Raymond Khargi; Matthew T Smith; Fenizia Maffucci; Hyezo Kwun; Nicholas R Suss; Andrew G Winer Journal: Medicina (Kaunas) Date: 2021-06-29 Impact factor: 2.430