OBJECTIVE To assess trends in patients' decisions to decline cancer surgery in the United States by race and ethnicity. BACKGROUND Racial and ethnic differences in declining potentially curative cancer surgery are suggested to be due to systemic inequities in healthcare access and mistrust of healthcare systems, among other factors. Despite ongoing national efforts to address these inequities, it is unknown whether differences in rates of declined cancer surgery have improved. METHODS Using population-based data from the US Surveillance, Epidemiology, and End Results Program from 2000 to 2019, we studied individuals with non-metastatic cancer who were recommended surgery. Racial and ethnic differences in risk-adjusted rates of declined surgery were evaluated by year and cancer site using mixed-effects logistic regression. RESULTS Of 2,740,129 patients with resectable, non-metastatic cancer, Black patients had the highest rates of declined surgery (2.10% [95% CI, 1.91-2.31%]) while White patients had the lowest (1.04% [95% CI, 0.95-1.14%]). From 2000 to 2019, racial and ethnic differences in declined surgery did not change significantly, except for a decrease in the difference between Hispanic and White patients (difference-in-difference, -0.4% [95% CI, -0.71% to -0.09%]). When stratified by cancer site, Black-White differences in rates of declined surgery decreased significantly (but were not eliminated) for four of fifteen sites (esophageal, pancreatic, lung, and kidney) ( P <0.001). CONCLUSIONS Patients from racial and ethnic minority groups were more likely to decline surgical intervention for potentially curable malignancies and these differences have persisted over time. Further work is needed to understand the causes of these differences and identify opportunities for improvement.

中文翻译：

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美国可切除恶性肿瘤手术减少的种族和民族差异趋势。


目的 评估美国患者因种族和民族而拒绝接受癌症手术的趋势。背景技术潜在治愈性癌症手术下降的种族和民族差异被认为是由于医疗保健获取方面的系统性不平等和对医疗保健系统的不信任等因素造成的。尽管各国正在努力解决这些不平等问题，但尚不清楚癌症手术率下降的差异是否有所改善。方法 使用 2000 年至 2019 年美国监测、流行病学和最终结果计划的基于人群的数据，我们研究了被建议接受手术的非转移性癌症个体。使用混合效应逻辑回归按年份和癌症部位评估拒绝手术的风险调整率的种族和民族差异。结果 在 2,740,129 名可切除的非转移性癌症患者中，黑人患者拒绝手术的比例最高（2.10% [95% CI, 1.91-2.31%]），而白人患者拒绝手术的比例最低（1.04% [95% CI, 0.95]） -1.14%]）。从 2000 年到 2019 年，拒绝手术的种族和民族差异没有显着变化，除了西班牙裔和白人患者之间的差异有所缩小（双重差异，-0.4% [95% CI，-0.71% 至 -0.09] %]）。当按癌症部位分层时，十五个部位（食管、胰腺、肺和肾）中的四个部位（食管、胰腺、肺和肾）的拒绝手术率的黑白差异显着下降（但未消除）（P <0.001）。结论 对于可能治愈的恶性肿瘤，来自种族和族裔群体的患者更有可能拒绝手术干预，并且这些差异随着时间的推移一直持续存在。 需要进一步的工作来了解这些差异的原因并确定改进的机会。