PO.PS01.03 · 人群科学
肺癌诊断分期在人口学、行为和社会经济因素方面的差异：来自马里兰大学医疗系统的EPIC EHR研究
Disparities across demographic, behavioral, and socioeconomic factors in lung cancer stage at diagnosis: An EPIC EHR study from the University of Maryland Medical System
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摘要 Abstract
中文摘要
背景：肺癌是马里兰州和美国癌症死亡的首要原因，其诊断分期存在性别、社会经济因素和保险状态方面的差异。年轻成人、从不吸烟者、女性和种族/族裔少数群体中的负担正在上升，他们常表现为晚期疾病，且根据当前USPSTF指南可能不符合筛查条件。在本研究中，我们利用大型真实世界EHR数据集，评估年龄、吸烟状态、种族、性别和保险状态与诊断分期之间的关联。
方法：我们对2016年1月至2024年12月期间使用马里兰大学医疗系统EPIC电子病历诊断为肺癌（ICD-10：C34）的6,446名成人进行了回顾性横断面研究。我们从病历中提取了年龄、性别、种族、族裔、吸烟状态、保险类型和诊断分期，后者分类为早期（I-II）或晚期（III-IV）。我们对连续变量使用t检验，对分类变量使用χ²检验。
结果：总体而言，38%的患者诊断为早期肺癌，62%为晚期疾病。晚期疾病在较年轻患者中更常见（平均年龄68岁对70岁，p < 0.001），以及在50岁以下者中（77%，p < 0.001）。尽管研究人群中女性更多（52%），但男性更可能表现为晚期疾病（64%对59%，p < 0.001）。研究人群以白人为主（73%），但种族与分期之间无关联（p=0.06）。当前吸烟者最可能表现为晚期疾病（66%，p < 0.001）。与享有Medicare（58%）或私人保险（66%）者相比，接受Medicaid（78%）的患者和无保险者（65%）诊断为晚期的可能性更高。
结论：年轻成人、男性、当前吸烟者以及接受Medicaid或无保险的患者更可能表现为晚期肺癌。这些发现凸显了肺癌诊断中的差异，并强调了进一步研究的必要性。
查看英文原文 English abstract
Background: Lung cancer is the leading cause of cancer mortality in Maryland and the US with sex, socioeconomic factors, and insurance status disparities in stage at diagnosis. There is a rising burden among younger adults, never-smokers, women and racial/ethnic minorities, who often present with advanced disease and may not qualify for screening using current USPSTF guidelines. In this study, we evaluate the associations between age, smoking status, race, sex, and insurance status, and the stage at diagnosis using large real-world EHR datasets.
Methods: We conducted a retrospective cross-sectional study of 6,446 adults diagnosed with lung cancer (ICD-10: C34) using EPIC electronic medical records from the University of Maryland Medical System between January 2016 and December 2024. We extracted age, sex, race, ethnicity, smoking status, insurance type, and stage at diagnosis classified as early (I-II) or advanced (III-IV) from the records. We used t tests for continuous variables and χ² tests for categorical variables.
Results: Overall, 38% of patients were diagnosed with early-stage lung cancer and 62% with advanced disease. Advanced stage disease was commoner among younger patients, (mean age 68 vs 70 years, p<0.001), and those younger than 50 years (77%, p<0.001). Though there were more women (52%) in the study population, men were more likely to present with advanced disease (64% vs 59%, p<0.001). The study population was predominantly white (73%) but there was no association between race and stage (p=0.06). Current smokers were most likely to present with advanced disease (66%, p<0.001). Patients on Medicaid (78%) and uninsured individuals (65%) had a higher likelihood of advanced-stage diagnosis compared with those covered by Medicare (58%) or private insurance (66%).
Conclusions: Younger adults, males, current smokers, and patients on Medicaid or having no insurance were more likely to present with advanced lung cancer. These findings highlight disparities in lung cancer diagnosis and underscore the need for further research.
利益披露 Disclosure
L. Abar, None..
C. Adebamowo, None.