Abstract

Background

Access to treatment for glioblastoma (GBM) can be impacted by multiple demographic parameters. Barriers specific to the Hispanic population of the United States (US) are not fully understood. Therefore, the aim of this study was to elucidate geographic disparities for access to GBM treatment in the US Hispanic population.

Methods

All GBM patients with known Hispanic ethnicity status (and Caucasian race) in the US National Cancer Database (NCDB) between the years 2005–2016 were retrospectively reviewed. Treatment statuses of surgical resection, chemotherapy, radiation therapy and triple therapy (resection, chemotherapy and radiation) were summarized, and analyzed by comparison and regression analyses over US Census regions.

Results

A total cohort size of 40,232 Caucasian GBM patients were included, with 3,111 (8%) identifying as Hispanic. The odds of treatment by chemotherapy (OR 0.78, P < 0.01), radiation therapy (OR 0.82, P < 0.01) and triple therapy (OR 0.84, P < 0.01) were all significantly lower in the Hispanic group versus non-Hispanic group. The odds of being treated in the Hispanic group were significantly lower in multiple Census regions with respect to surgical resection (New England, OR 0.51; Mountain, OR 0.68), chemotherapy (East North Central, OR 0.77; Middle Atlantic, OR 0.71; Pacific, OR 0.77), radiation therapy (Middle Atlantic, OR 0.77) and triple therapy (New England, OR 0.49; Middle Atlantic, OR 0.87; Pacific, OR 0.84). Significant barriers to triple therapy in the Hispanic group within these regions were older age (OR 0.97; P < 0.01), treatment in a community facility (OR 0.85, P = 0.03), lack of insurance (OR 0.71, P = 0.03), yearly income < $40,227 (OR 0.69, P < 0.01), low education levels (OR 0.75, P = 0.03) and presence of co-morbidity (OR 0.82; P < 0.01).

Conclusions

Currently in the US, there exists heterogenous geographic disparities for Hispanic GBM patients to access different treatments compared to non-Hispanic patients. Multiple circumstances can influence access to treatment within the Hispanic community of these regions, and greater investigation with more granularity required to reveal mechanisms in which these disparities may be addressed in the future.

中文翻译：

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美国基于西班牙裔种族的胶质母细胞瘤治疗的地域差异：来自国家数据库的见解。

摘要

背景

胶质母细胞瘤（GBM）的治疗方法可能会受到多种人口统计学参数的影响。尚未完全了解针对美国西班牙裔人口的特定障碍。因此，本研究的目的是阐明美国拉美裔人口在获得GBM治疗方面的地理差异。

方法

回顾性分析了2005-2016年间美国国家癌症数据库（NCDB）中所有已知西班牙裔种族状态（和白种人）的GBM患者。总结了手术切除，化学疗法，放射疗法和三联疗法（切除，化学疗法和放射）的治疗状态，并通过对美国人口普查地区的比较和回归分析进行了分析。

结果

包括40232名白种人GBM患者的总队列大小，其中3111名（8％）被确定为西班牙裔。与非西班牙裔组相比，西班牙裔组中化疗（OR 0.78，P <0.01），放疗（OR 0.82，P <0.01）和三联疗法（OR 0.84，P <0.01）的几率均显着降低。在多个手术普查区域（新英格兰，OR 0.51； Mountain，OR 0.68），化学疗法（东中北部，OR 0.77；中大西洋，OR 0.71；太平洋地区），西班牙裔人群在多个普查地区接受治疗的几率显着降低。 ，或0.77），放射疗法（中大西洋，或0.77）和三联疗法（新英格兰，或0.49；中大西洋，或0.87；太平洋，或0.84）。在这些地区，西班牙裔人群接受三联疗法的主要障碍是年龄较大（OR 0.97； P <0.01），

结论

目前在美国，与非西班牙裔患者相比，西班牙裔GBM患者在接受不同治疗方面存在异质地理差异。多种情况可能会影响这些地区的西班牙裔社区获得治疗的机会，并且需要进行更详细的调查才能揭示出将来可能会解决这些差异的机制。