海报库PosterKeep
PO.PS01.09 · 人群科学

符合条件的西班牙裔和亚裔美国患者中肝细胞癌监测的多层次决定因素：语言一致性与族裔聚居区

Multilevel determinants of hepatocellular carcinoma surveillance in eligible Hispanic and Asian American patients: Language concordance and ethnic enclaves

编号 7605 展板 25 时间 4/22 09:00–12:00 区域 Section 35 主讲 Caroline Thompson, PhD
分会场 Risk Prediction Modeling, Screening, Early Detection, and Preneoplastic and Tumor Markers
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作者与单位 Authors & Affiliations

Caroline A. Thompson1, Enyao Zhang1, Mindy C. Hebert-DeRouen2, Alison J. Canchola2, Alyssa Cortella2, Terri Rice2, Pushkar P. Inamdar2, Mai Vu3, Pragati Kenkare3, Janet N. Chu4, Anna D. Rubinsky5, Chanda Ho6, Su-Ying Liang3, Hashem B. El-Serag7, Michele M. Tana4, Ma Somsouk4, Mark Segal2, Mi-Ok Kim2, Iona C. Cheng2, Scarlett L. Gomez5, Salma Shariff-Marco2

1Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC,2Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA,3Palo Alto Medical Foundation Research Institute, Palo Alto, CA,4Medicine, University of California San Francisco, San Francisco, CA,5University of California San Francisco, San Francisco, CA,6California Pacific Medical Center, San Francisco, CA,7Baylor College of Medicine, Houston, TX

摘要 Abstract

中文摘要
在高风险的西班牙裔和亚裔美国人群中，肝细胞癌（HCC）监测采用率较低，这可能受到医疗提供者沟通和/或邻里环境的影响。我们在一个大型、多元化的加州医疗系统中研究了患者-提供者语言一致性、邻里族裔聚居区与HCC监测之间的关联。我们分析了Sutter Health（2000—2016年）的电子健康记录数据，并附加了普查区级别的族裔聚居区指数（近期移民比例、讲西班牙语/亚洲语言家庭及英语能力有限、西班牙裔/亚裔居民比例）。符合条件的成人须有指定的初级保健提供者（PCP）、≥1次就诊、有效地址、无肝癌病史、有监测指征（肝硬化或慢性乙型/丙型肝炎）、随访≥18个月，并自我认定为西班牙裔（HA）或亚裔美国人（AA）。监测为每6个月一次超声检查和/或增强CT/MRI（含或不含甲胎蛋白）。我们将采用率定义为≥1次检测，将依从性定义为受监测者中处于最新状态的时间百分比（PTUDS）。我们评估了语言一致性（PCP会讲患者的非英语语言）和族裔聚居区（五分位数；Q5=最高）。采用带机构聚类的分层logistic/线性回归估计OR（采用率）和beta值（PTUDS），并对人口统计学、随访时间、就诊利用情况进行校正。共纳入N=11,311名患者（3,444名HA，7,867名AA）；19%的HA和28%的AA为非英语使用者；38%的HA和55%的AA居住在Q5聚居区。总体而言，36%的HA和43%的AA接受了监测（PTUDS中位数：HA 0.16，AA 0.15）。在AA中，与英语使用者相比，语言一致的非英语使用者采用率更高（OR=1.35，95%CI 1.12—1.62）且依从性更高（beta=0.024，95%CI 0.009—0.039），而语言不一致的非英语使用者采用率相似（OR=1.01，95%CI 0.88—1.16）但依从性更高（beta=0.020，95%CI 0.008—0.032）。在HA中，语言一致的非英语使用者的采用率/依从性与英语使用者相似，但语言不一致的非英语使用者采用率更高（OR=1.43，95%CI 1.16—1.76）。族裔聚居区在AA中无关联（p趋势=0.46），但HA采用率与聚居区呈负相关（Q1 vs. Q5，OR=0.79，95%CI 0.59—1.07，p趋势=0.01）。依从性与聚居区无关联。患者-提供者语言一致性和邻里族裔聚居区对HCC监测的影响因种族/族裔而异。AA监测与语言一致的提供者相关，但与聚居区无关；HA监测与聚居区相关，但与提供者语言无关。这些差异模式提示了量身定制的干预目标：为亚洲语言招募多语种提供者，以及利用西班牙裔社区现有网络开展基于社区的外展工作。
查看英文原文 English abstract
Low hepatocellular carcinoma (HCC) surveillance uptake among high-risk Hispanic and Asian American populations may be influenced by provider communication and/or neighborhood context. We investigated associations between patient-provider language concordance, neighborhood ethnic enclave and HCC surveillance in a large, diverse California health system. We analyzed electronic health record data from Sutter Health (2000-2016) appended to census tract-level ethnic enclave indices (% recent immigrants, Spanish/Asian language-speaking households and limited English proficiency, % Hispanic/Asian residents). Eligible adults had an assigned primary care provider (PCP), ≥1 encounter, valid address, no liver cancer history, surveillance indication (cirrhosis or chronic hepatitis B/C), ≥18 months follow-up, and self-identified as Hispanic (HA) or Asian American (AA). Surveillance was ultrasound every 6 months and/or contrast-enhanced CT/MRI (with/without alpha-fetoprotein). We defined uptake as ≥1 test and adherence as percent time up-to-date (PTUDS) among those surveilled. We assessed language concordance (PCP spoke patient's non-English language) and ethnic enclave (quintiles; Q5=highest). Hierarchical logistic/linear regression with facility clustering estimated ORs (uptake) and betas (PTUDS), adjusting for demographics, follow-up time, utilization. N=11,311 patients were included (3,444 HA, 7,867 AA); 19% of HAs and 28% of AAs were non-English speakers; 38% of HAs and 55% of AAs lived in Q5 enclaves. Overall, 36% of HAs and 43% of AAs were surveilled (median PTUDS: 0.16 HA, 0.15 AA). Among AAs, compared to English speakers, language-concordant non-English speakers had higher uptake (OR=1.35, 95%CI 1.12-1.62) and adherence (beta=0.024, 95%CI 0.009-0.039), while non-concordant non-English speakers had similar uptake (OR=1.01, 95%CI 0.88-1.16) but higher adherence (beta=0.020, 95%CI 0.008-0.032). Among HAs, language-concordant non-English speakers showed similar uptake/adherence to English speakers, but non-concordant non-English speakers had higher uptake (OR=1.43, 95%CI 1.16-1.76). Ethnic enclave showed no AA association (p-trend=0.46) but HA uptake was inversely associated with enclave (OR=0.79 comparing Q1 vs. Q5, 95%CI 0.59-1.07, p-trend=0.01). Adherence was not associated with enclave. Patient-provider language concordance and neighborhood ethnic enclave influenced HCC surveillance differently by race/ethnicity. AA surveillance was associated with language-concordant providers but not enclave; HA surveillance was associated with enclave but not provider language. These differential patterns suggest tailored intervention targets: multilingual provider recruitment for Asian languages, and community-based outreach leveraging existing networks in Hispanic neighborhoods.
利益披露 Disclosure
C. A. Thompson, None.. E. Zhang, None.. M. C. Hebert-DeRouen, None.. A. J. Canchola, None.. A. Cortella, None.. T. Rice, None.. P. P. Inamdar, None.. M. Vu, None.. P. Kenkare, None.. J. N. Chu, None.. A. D. Rubinsky, None.. C. Ho, None.. S. Liang, None.. H. B. El-Serag, None.. M. M. Tana, None.. M. Somsouk, None.. M. Segal, None.. M. Kim, None.. I. C. Cheng, None.. S. L. Gomez, None.. S. Shariff-Marco, None.

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