美国医疗保健体系中的结构性种族主义导致了肿瘤治疗中的不平等。本研究旨在研究社会经济因素，探究种族隔离对肝胰胆癌（HPB）不公平的影响。利用关联的Surveillance, Epidemiology, and End Results（SEER）-Medicare数据库（2005-2015年）和2010年人口普查数据，识别出患有HPB癌症的黑人和白人患者。根据诊断时肿瘤阶段、手术切除和总体死亡率，检测了分离指数（IoD）作为隔离的有效测量指标。采用主成分分析和结构方程模型确定了社会经济因素的中介作用。在39,063例患者中，86.4 %（n = 33,749）为白人，13.6 %（n = 5,314）为黑人。黑人患者更可能生活在分离区域（IoD，0.62 vs. 0.52；p < 0.05）。高度隔离区域中的黑人患者相对于低隔离区域中的白人患者，更不可能呈现早期疾病（相对风险[RR]，0.89；95%置信区间[CI] 0.82-0.95），不会接受针对局部疾病的手术切除（RR，0.81；95% CI 0.70-0.91），并且具有更高的死亡风险（风险比1.12，95% CI 1.06-1.17）（所有p < 0.05）。中介分析发现，贫困、缺乏保险、受教育水平、拥挤的生活条件、通勤时间和支持性收入等因素是早期阶段表现的差异的25%的原因。平均收入、房价和收入流动性解释了手术切除差距的17%。值得注意的是，平均收入、房价和收入流动性中介了种族隔离对长期生存率产生的59%的影响。种族隔离通过基础社会经济因素的中介作用，根据肝胰胆癌患者手术护理和结果的显着差异。©2023年。外科肿瘤学会。

Structural racism within the U.S. health care system contributes to disparities in oncologic care. This study sought to examine the socioeconomic factors that underlie the impact of racial segregation on hepatopancreaticobiliary (HPB) cancer inequities.Both Black and White patients who presented with HPB cancer were identified from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2005-2015) and 2010 Census data. The Index of Dissimilarity (IoD), a validated measure of segregation, was examined relative to cancer stage at diagnosis, surgical resection, and overall mortality. Principal component analysis and structural equation modeling were used to determine the mediating effect of socioeconomic factors.Among 39,063 patients, 86.4 % (n = 33,749) were White and 13.6 % (n = 5314) were Black. Black patients were more likely to reside in segregated areas than White patients (IoD, 0.62 vs. 0.52; p < 0.05). Black patients in highly segregated areas were less likely to present with early-stage disease (relative risk [RR], 0.89; 95 % confidence interval [CI] 0.82-0.95) or undergo surgery for localized disease (RR, 0.81; 95% CI 0.70-0.91), and had greater mortality hazards (hazard ratio 1.12, 95% CI 1.06-1.17) than White patients in low segregation areas (all p < 0.05). Mediation analysis identified poverty, lack of insurance, education level, crowded living conditions, commute time, and supportive income as contributing to 25 % of the disparities in early-stage presentation. Average income, house price, and income mobility explained 17 % of the disparities in surgical resection. Notably, average income, house price, and income mobility mediated 59 % of the effect that racial segregation had on long-term survival.Racial segregation, mediated through underlying socioeconomic factors, accounted for marked disparities in access to surgical care and outcomes for patients with HPB cancer.© 2023. Society of Surgical Oncology.