与非西班牙裔白人 (NHW) 美国人相比，非西班牙裔黑人 (NHB) 美国人的结直肠癌 (CRC) 发病率更高，生存率更差，但生物因素与获得医疗服务的相对贡献仍不清楚。这项研究使用了不同医疗保健背景下的两个全国性队列来研究卫生系统对这种差异的影响。我们使用来自监测、流行病学和最终结果 (SEER) 登记处以及美国退伍军人健康管理局 (VA) 的数据来识别成年人2010 年至 2020 年间被诊断患有结直肠癌且被确定为非西班牙裔黑人 (NHB) 或非西班牙裔白人 (NHW) 的人。使用总体生存的主要终点进行分层生存分析，并使用癌症特异性生存进行敏感性分析。我们在 SEER 登记中确定了 263,893 名 CRC 患者（36,662 (14%) NHB；226,271 (86%) NHW）和 24,375 VA 患者（4,860 (20%) NHB；19,515 (80%) NHW）。在 SEER 登记中，NHB 患者的 OS 比 NHW 患者差：中位 OS 为 57 个月（95% 置信区间 (CI) 55-58）对比 72 个月（95% CI 71-73）（风险比 (HR) 1.14， 95% CI 1.12-1.15，p = 0.001）。相比之下，VA NHB 中位 OS 为 65 个月（95% CI 62-69），而 NHW 为 69 个月（95% CI 97-71）（HR 1.02，95% CI 0.98-1.07，p= 0.375）。在 SEER 登记中，种族和医疗保险年龄资格之间存在显着的交互作用（p<<0.001）； NHB 种族对年龄 <65 岁的患者（HR 1.44，95% CI 1.39-1.49，p<0.001）比 ≥ 65 岁的患者（HR 1.13，95% CI 1.11-1.15，p<0.001）影响更大。在 VA 中，年龄分层不显着 (p = 0.21)。美国普通人群中 CRC 生存率的种族差异在医疗保险年龄患者中显着减弱。退伍军人管理局不存在这种模式，这表明获得护理可能是这种疾病种族差异的重要组成部分。版权所有 © 2024 Riviere, Morgan, Deshler, Demb, Mehtsun, Martinez, Gupta, Banegas, Murphy and Rose。

Non-Hispanic Black (NHB) Americans have a higher incidence of colorectal cancer (CRC) and worse survival than non-Hispanic white (NHW) Americans, but the relative contributions of biological versus access to care remain poorly characterized. This study used two nationwide cohorts in different healthcare contexts to study health system effects on this disparity.We used data from the Surveillance, Epidemiology, and End Results (SEER) registry as well as the United States Veterans Health Administration (VA) to identify adults diagnosed with colorectal cancer between 2010 and 2020 who identified as non-Hispanic Black (NHB) or non-Hispanic white (NHW). Stratified survival analyses were performed using a primary endpoint of overall survival, and sensitivity analyses were performed using cancer-specific survival.We identified 263,893 CRC patients in the SEER registry (36,662 (14%) NHB; 226,271 (86%) NHW) and 24,375 VA patients (4,860 (20%) NHB; 19,515 (80%) NHW). In the SEER registry, NHB patients had worse OS than NHW patients: median OS of 57 months (95% confidence interval (CI) 55-58) versus 72 months (95% CI 71-73) (hazard ratio (HR) 1.14, 95% CI 1.12-1.15, p = 0.001). In contrast, VA NHB median OS was 65 months (95% CI 62-69) versus NHW 69 months (95% CI 97-71) (HR 1.02, 95% CI 0.98-1.07, p = 0.375). There was significant interaction in the SEER registry between race and Medicare age eligibility (p < 0.001); NHB race had more effect in patients <65 years old (HR 1.44, 95% CI 1.39-1.49, p < 0.001) than in those ≥65 (HR 1.13, 95% CI 1.11-1.15, p < 0.001). In the VA, age stratification was not significant (p = 0.21).Racial disparities in CRC survival in the general US population are significantly attenuated in Medicare-aged patients. This pattern is not present in the VA, suggesting that access to care may be an important component of racial disparities in this disease.Copyright © 2024 Riviere, Morgan, Deshler, Demb, Mehtsun, Martinez, Gupta, Banegas, Murphy and Rose.