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目的探讨非小细胞肺癌(NSCLC)病人中行正电子发射体层摄影(PET)检查的人口和区域性因素,并确定这些因素与PET使用的相关性是否随时间推移而改变。材料与方法美国北卡罗来纳州大学人类研究伦理办公室和杜克大学卫生体系的机构审查委员会批准(免除知情同意)对在1998—2007年间被诊断NSCLC的医保受益人的监督流行病学和最终结果的医保数据进行回顾性分析。最初的成果为每年度和社会人口亚群在诊断的2个月前至4个月后PET检查数量上的变化。采用χ2检验比较人口统计学和地理学亚群及早期(1998—2000年)和晚期(2005—2007年)的PET使用。在研究期间,应用Logit和线性概率多变量回归分析对PET使用的相关因素进行进一步检验。结果最终人群包括46544例病人,45935例NSCLC。到2005年,不论人口亚群,一半以上的病人接受过一次或更多次PET检查。在多变量Logistic回归分析中,接受过PET检查的病人更可能是已婚的、非黑人种、80岁以下、住在人口普查区域且有较高教育水平,或者住在东北部(均P<0.001)。最初,行PET检查与其周边40英里以内的距离相关(P<0.001),但这种相关到2007年便消失了。在非黑人病人(P≤0.01)、81岁以下的病人(P<0.001)和住在东北部和南部的病人(P<0.001)中,检查率明显迅速增加。结论在NSCLC的医保受益人中,PET检查最初是集中在81岁以下的非黑人病人。尽管所有亚群普遍接受此检查,但在人口统计学亚群中仍然存在差异。
Objective To investigate the population and regional factors of positron emission tomography (PET) in patients with non-small cell lung cancer (NSCLC) and to determine if the association of these factors with PET use changes over time. MATERIALS AND METHODS Oversight Epidemiology and Final Outcomes of Medicare-Insured Benefit Individuals in NSCLC Diagnosed Between 1998 and 2007 Approved (Excluded informed consent) by the Institutional Review Board of Human Studies Ethics Office of North Carolina University and Duke University Health System Medicare data were retrospectively analyzed. The initial outcome was the change in the number of PET exams between the annual and social demographic subgroups two to four months after diagnosis. Chi-square test was used to compare demographics and geography subgroups with early (1998-2000) and late (2005-2007) PET use. During the study, Logit and linear probabilistic multivariate regression analysis were used to further examine the use of PET. Results The final population consisted of 46544 patients and 45935 NSCLC patients. By 2005, more than half of patients had one or more PET exams, regardless of their subpopulation. In Multivariate Logistic regression analysis, patients who underwent PET examination were more likely to be married, non-black, under 80, with higher education in the census area, or living in the northeast (P < 0.001). Initially, PET examination was associated with a distance within 40 miles of its circumference (P <0.001), but this correlation disappeared by 2007. The examination rate was significantly increased in non-black (P≤0.01), patients under 81 (P <0.001), and patients in the northeast and south (P <0.001). Conclusions Of the Medicare beneficiaries in NSCLC, PET was initially focused on non-black patients under 81 years of age. Although this test is generally accepted by all subgroups, differences remain in the demographic subgroup.