在美国，关于前列腺癌的种族/民族差异已有报道。然而，前列腺癌患者中所有因素和原因特异性死亡的种族/民族差异的长期趋势和贡献仍不清楚。我们分析了在美国25年内前列腺癌幸存者的种族/民族差异的趋势和贡献者，根据死因进行研究。在这项回顾性、基于人口的纵向队列研究中，我们使用美国癌症登记处的人口癌症登记数据（来自“观察、流行病学和终结果”计划）识别了在1995年至2019年间首次诊断为原发性前列腺癌的患者，并进行了截至2019年12月31日的随访。我们计算了每个种族/民族群体（黑人、白人、西班牙裔、亚裔或太平洋岛民 [API]，以及美洲印第安人或阿拉斯加原住民 [AI/AN]）在诊断期和死因方面的死亡累积发病率。我们使用Cox回归模型量化了绝对差异，即在种族/民族群体和诊断期之间的5年死亡累积发病率的变动率。我们还估计了相对（危险比 [HR]）种族/民族差异和可能因素对种族/民族差异的贡献率百分比。尽管在五个种族/民族群体中，死亡风险的累积风险呈下降趋势，然而在1995年至2019年期间，AI/AN和黑人患者始终具有最高的死亡率，调整后的HR分别为1.48（1.40-1.58）和1.40（1.38-1.42）。AI/AN与白人患者之间的全因死亡差距随时间增加，调整后的HR在1995-1999年为1.32（1.17-1.49），在2015-2019年为1.95（1.53-2.49）。对诊断阶段、初始治疗、肿瘤分级和家庭收入进行调整后，我们发现33%和24%的AI/AN-白人和黑人-白人之间的全因死亡差距可以解释。前列腺癌患者中种族/民族差异的持续存在，需要采取新的措施来消除卫生差异。我们的研究提供了重要的证据和解决种族/民族不平等的途径。中国国家重点研发计划、国家自然科学基金、北京市医院管理局临床医学发展特殊资助、北京大数据基于精准医学高级创新中心的开放研究基金、中国教育部哲学社会科学研究重点项目。 © 2023 The Author(s).

Racial/ethnic disparities in prostate cancer are reported in the United States (US). However, long-term trends and contributors of racial/ethnic disparities in all-cause and cause-specific death among patients with prostate cancer remain unclear. We analysed the trends and contributors of racial/ethnic disparities in prostate cancer survivors according to the cause of death in the US over 25 years.In this retrospective, population-based longitudinal cohort study, we identified patients diagnosed with first primary prostate cancer between 1995 and 2019, with follow-up until Dec 31, 2019, using population-based cancer registries' data from the Surveillance, Epidemiology, and End Results (SEER) Program. We calculated the cumulative incidence of death for each racial/ethnic group (Black, white, Hispanic, Asian or Pacific Islander [API], and American Indian or Alaska Native [AI/AN] people), by diagnostic period and cause of death. We quantified absolute disparities using rate changes for the 5-year cumulative incidence of death between racial/ethnic groups and diagnostic periods. We estimated relative (Hazard ratios [HR]) racial/ethnic disparities and the percentage of potential factors contributed to racial/ethnic disparities using Cox regression models.Despite a decreasing trend in the cumulative risk of death across five racial/ethnic groups, AI/AN and Black patients consistently had the highest rate of death between 1995 and 2019 with an adjusted HR of 1.48 (1.40-1.58) and 1.40 (1.38-1.42) respectively. The disparities in all-cause mortality between AI/AN and white patients increased over time, with adjusted HR 1.32 (1.17-1.49) in 1995-1999 and 1.95 (1.53-2.49) in 2015-2019. Adjustment of stage at diagnosis, initial treatment, tumor grade, and household income explained 33% and 24% of the AI/AN-white and Black-white disparities in all-cause death among patients with prostate cancer.The enduring racial/ethnic disparities in patients with prostate cancer, call for new interventions to eliminate health disparities. Our study provides important evidence and ways to address racial/ethnic inequality.National Key R&D Program of China, National Natural Science Foundation of China, Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support, the Open Research Fund from Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Key Projects of Philosophy and Social Sciences Research, Ministry of Education of China.© 2023 The Author(s).