Background Clinical trial participation at Comprehensive Cancer Centers (CCC) is inequitable for minoritized race/ethnic groups with acute leukemia. CCCs care for a high proportion of adults with acute leukemia. It is unclear if participation inequities are due to CCC access, post-access enrollment, or both. Methods We conducted a retrospective cohort study of adults with acute leukemia (2010-2019) residing within Massachusetts, the designated catchment area of the Dana-Farber/Harvard Cancer Center (DF/HCC). Individuals were categorized as non-Hispanic Asian (NHA), Black (NHB), White (NHW), Hispanic White (HW), or Other. Decomposition analyses assessed covariate contributions to disparities in (1) access to DF/HCC care and (2) post-access enrollment. Results Of 3698 individuals with acute leukemia, 85.9% were NHW, 4.5% HW, 4.3% NHB, 3.7% NHA, and 1.3% Other. Access was lower for HW (age- and sex-adjusted OR 0.64 95%CI 0.45,0.90) and reduced post-access enrollment for HW (aOR 0.54 95%CI 0.34,0.86) and NHB (aOR 0.60 95%CI 0.39,0.92) compared to NHW. Payor and socioeconomic status (SES) accounted for 25.2% and 21.2% of the +1.1% absolute difference in HW access. Marital status and SES accounted for 8.0% and 7.0% of the -8.8% absolute disparity in HW enrollment; 76.4% of the disparity was unexplained. SES and marital status accounted for 8.2% and 7.1% of the -9.1% absolute disparity in NHB enrollment; 73.0% of the disparity was unexplained. Conclusions A substantial proportion of race/ethnic inequities in acute leukemia trial enrollment at CCCs are from post-access enrollment, the majority of which was not explained by sociodemographic factors.

中文翻译：

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种族/民族与综合癌症中心准入和急性白血病临床试验注册的关联

背景 对于患有急性白血病的少数种族/族裔群体来说，综合癌症中心 (CCC) 的临床试验参与是不公平的。 CCC 照顾大部分患有急性白血病的成人。目前尚不清楚参与不平等是否是由于 CCC 准入、准入后注册或两者兼而有之。方法 我们对居住在马萨诸塞州（达纳法伯/哈佛癌症中心 (DF/HCC) 的指定服务区）的成人急性白血病患者（2010-2019 年）进行了回顾性队列研究。个人被分为非西班牙裔亚裔 (NHA)、黑人 (NHB)、白人 (NHW)、西班牙裔白人 (HW) 或其他。分解分析评估了协变量对以下方面差异的贡献：(1) 获得 DF/HCC 护理和 (2) 获得后登记。结果 3698 例急性白血病患者中，NHW 占 85.9%，HW 占 4.5%，NHB 占 4.3%，NHA 占 3.7%，其他占 1.3%。 HW 的访问率较低（年龄和性别调整 OR 0.64 95%CI 0.45,0.90），HW 的访问后注册人数减少（aOR 0.54 95%CI 0.34,0.86）和 NHB（aOR 0.60 95%CI 0.39,0.92） ）与 NHW 相比。医疗服务获取方面+1.1%的绝对差异中，付款人和社会经济地位（SES）分别占25.2%和21.2%。婚姻状况和社会经济地位分别占家庭卫生入学人数-8.8%绝对差距的8.0%和7.0%； 76.4% 的差异无法解释。 NHB 入学人数绝对差异 -9.1% 中，SES 和婚姻状况分别占 8.2% 和 7.1%； 73.0% 的差异无法解释。结论 CCC 急性白血病试验入组中的种族/民族不平等很大一部分来自入组后，其中大部分不能用社会人口学因素来解释。