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Patterns of venous thromboembolism risk, treatment, and outcomes among patients with cancer from uninsured and vulnerable populations
American Journal of Hematology ( IF 12.8 ) Pub Date : 2022-05-31 , DOI: 10.1002/ajh.26623
Wilson L da Costa 1 , Danielle Guffey 2 , Abiodun Oluyomi 1 , Raka Bandyo 3, 4 , Omar Rosales 1 , Courtney D Wallace 4 , Carolina Granada 5 , Nimrah Riaz 5 , Margaret Fitzgerald 6 , David A Garcia 7 , Marc Carrier 8 , Christopher I Amos 1, 2 , Christopher R Flowers 9 , Ang Li 5
Affiliation  

The epidemiology of cancer-associated thrombosis (CAT) among uninsured and vulnerable populations in the US is not well-characterized. We performed a retrospective cohort study for patients with newly diagnosed cancer from 2011 to 2020 at Harris Health System, which cares for uninsured residents in the Houston metropolitan area. Patient demographics, NCI comorbidity index, area of deprivation index (ADI), cancer histology, staging, and systemic therapy data were extracted. CAT included overall venous thromboembolism (VTE) or pulmonary embolism +/− lower extremity deep vein thrombosis (PE/LE-DVT) within 1 year of diagnosis. We used multivariable Fine-Gray models to assess the associations with CAT accounting for death as a competing risk. Among 15 342 patients, 74% were uninsured and 84% lived in socioeconomically disadvantaged neighborhoods. There were 16% Non-Hispanic White (NHW), 28% Non-Hispanic Black (NHB), 50% Hispanic (27% Mexican), and 6% Asian/Pacific Islanders (API). The 1-year CAT incidence rate was 14.6%. Overall VTE was lower for Hispanics versus NHW (SHR 0.87 [0.76–0.99]) and API versus NHW (SHR 0.58 [0.44–0.77]). PE/LE-DVT was higher for NHB versus NHW (SHR 1.18 [1.01–1.39]). CAT was also associated with chemotherapy-based regimens (+/− immunotherapy), age, obesity, cancer type/staging, VTE history, and recent hospitalization. NCI comorbidity and ADI scores were associated with mortality but not CAT. In a large cohort of underserved patients with cancer, we identified an elevated incidence of CAT with known and novel risk predictors. Hispanics had lower adjusted rates of CAT and mortality. Our findings highlight the need to investigate and incorporate vulnerable populations in clinical trials.

中文翻译:

来自未保险和弱势人群的癌症患者的静脉血栓栓塞风险、治疗和结果的模式

美国未保险人群和弱势人群中癌症相关血栓形成 (CAT) 的流行病学特征尚不明确。我们对 Harris Health System 2011 年至 2020 年新诊断出的癌症患者进行了一项回顾性队列研究,该系统为休斯敦大都会地区未投保的居民提供护理。提取了患者人口统计学、NCI 合并症指数、剥夺面积指数 (ADI)、癌症组织学、分期和全身治疗数据。CAT 包括诊断后 1 年内的整体静脉血栓栓塞 (VTE) 或肺栓塞 +/- 下肢深静脉血栓形成 (PE/LE-DVT)。我们使用多变量 Fine-Gray 模型来评估与将死亡作为竞争风险的 CAT 的关联。在 15342 名患者中,74% 没有保险,84% 生活在社会经济条件差的社区。有 16% 的非西班牙裔白人 (NHW)、28% 的非西班牙裔黑人 (NHB)、50% 的西班牙裔(27% 墨西哥人)和 6% 的亚洲/太平洋岛民 (API)。1年CAT发生率为14.6%。西班牙裔与 NHW (SHR 0.87 [0.76–0.99]) 和 API 与 NHW (SHR 0.58 [0.44–0.77]) 相比,总体 VTE 较低。NHB 的 PE/LE-DVT 高于 NHW(SHR 1.18 [1.01–1.39])。CAT 还与基于化疗的方案(+/- 免疫疗法)、年龄、肥胖、癌症类型/分期、VTE 病史和近期住院有关。NCI 合并症和 ADI 评分与死亡率相关,但与 CAT 无关。在一大群得不到充分服务的癌症患者中,我们发现 CAT 的发病率升高,并且存在已知和新的风险预测因素。西班牙裔的 CAT 和死亡率的调整率较低。
更新日期:2022-05-31
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