Confidence interval for the difference of two proportions has been studied for decades. Many methods were developed to improve the approximation of the limiting distribution of test statistics, such as the profile likelihood method, the score method, and the Wilson method. For the Wilson interval developed by Beal (Biometrics 43:941, 1987), the approximation of the Z test statistic to the standard normal distribution may be further improved by utilizing the continuity correction, in the observation of anti-conservative intervals from the Wilson interval. We theoretically prove that the Wilson interval is nested in the continuity corrected Wilson interval under mild conditions. We compare the continuity corrected Wilson interval with the commonly used methods with regards to coverage probability, interval width, and mean squared error of coverage probability. The proposed interval has good performance in many configurations. An example from a Phase II cancer trial is used to illustrate the application of these methods.
Introduction: Pancreatic cancer (PC) is currently the third-leading cause of cancer deaths in the United States. African Americans with PC have an increased incidence and worse survival outcome when compared to other racial groups. During the COVID-19 pandemic, there is evidence that hospital resources were allocated to treating immediate life-threatening conditions. Some of the daily highest case numbers were reported in the state of Florida with several peaks throughout 2020 and 2021. Additionally, the state of Florida has the second-highest rate of new cases of PC within the United States with an incidence of 4860/100,000. Our specific aim is to define the impact of COVID-19 between race, age, income, and gender on the survival time of newly diagnosed patients with pancreatic cancer in Florida. Materials and Methods: Patients with pancreatic adenocarcinoma diagnosed from January 1st, 2017 to October 31st, 2020 were identified through the statewide clinical research and network database called OneFlorida Clinical Consortium by using the ICD10 diagnosis code for pancreatic cancer. Patients were then placed into 3 cohorts based on date of pancreatic cancer diagnosis: pre-pandemic (01/01/2017- 09/30/2019), transition (10/01/2019-02/28/2020), and pandemic (03/1/2020-10/31/2020). Patients with a diagnosis of neuroendocrine carcinoma were excluded. Patients were followed for at least one year unless a death occurred. Summary statistics were reported for demographic variables (age, sex, income, gender). Kaplan-Meier analysis with log-rank test was performed to compare the difference in overall survival time among groups. Results: This retrospective study had a total of 934 unique patients available for analysis. Of the 934 patients, 81.3% were in the pre-pandemic cohort (n= 759), 8.2% transition cohort (n=77), and 10.5% pandemic cohort (n=98). There was a decrease in the rate of diagnosis from the pre-pandemic (23 per month) to pandemic cohort (12.2 per month). The demographic distribution of the sample was 23.4% Black, 68.7% White and 7.9% Other. The median age was 67 years (27–89). There were 49.8% women and 50.2% men. The median income was $52,915 ($23,704–$124,821). The differences in overall survival time were not significant for age and gender across the 3 cohorts. Income <$53,000 had significantly lower survival time across the 3 cohorts. African Americans had significantly lower survival time for pre-pandemic and transition cohort (p< .005), but Caucasians had the lowest survival time for the pandemic cohort (p <.005). When stratified for stage, the mean survival (in months) for White vs. Black populations was 37.8 vs. 26.1 for stage I, 37.6 vs. 27.3 for stage II, 28.5 vs.18.77 for stage III, and 20.7 vs. 21.7 for stage IV. Discussion: This study demonstrated a decrease in diagnosis & survival rate during the COVID-19 pandemic in Florida. Dissemination of resources should target these disparities in income and race. Citation Format: Guettchina Telisnor, Alexander S. Lim, Zhongyue Zhang, XiangYang Lou, Ibrahim Nassour, Bo Han, Edward Agyare, Sherise C. Rogers. Impact of COVID-19 on pancreatic cancer outcomes in Florida [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A048.
Introduction Pancreatic cancer (PC) portends a poor prognosis, is the current third-leading cause of cancer deaths in the United States, and is still rising. The state of Florida has the second-highest rate of new cases of PC within the United States with an incidence of 460/100,000. It is also a disease with significant disparities. African Americans with PC have a 50–90% increased incidence, lower rates of surgery, and worse overall mortality in comparison to other racial groups. With increased knowledge of these disparities in recent years, we sought out to identify whether these differences were present in the state of Florida by examining differences in pancreatic cancer survival outcomes between race, age, and income. Materials and Methods Patients with pancreatic adenocarcinoma diagnosed from January 1st, 2017 to October 31st, 2020 were identified through the statewide clinical research and network database called OneFlorida Clinical Consortium (OneFlorida) by using the ICD10 diagnosis code for pancreatic cancer. Patients with a diagnosis of neuroendocrine carcinoma were excluded. Patients were followed for at least one year unless a death occurred. Summary statistics were reported for demographic variables. The demographic variable for income was stratified by low being < $53,000 and high being ≥ $53,000. Kaplan-Meier analysis with log-rank test was performed to compare the difference in overall survival time among groups. Cox proportional hazards models were also fitted to test the between-group differences and compute the 95% confidence intervals of hazard ratio, while adjusting for informative covariate(s) when necessary. Results A total of 2,739 unique patients were available for analysis. The distribution of the sample was 68.7% White, 23.4% Black, and 7.9% Other. The median age was 67 years (27–89). There were 49.8% women and 50.2% men. The median income was $52,915 ($23,704–$124,821). Significant differences in overall survival were detected (p-values < 0.001) between age, income, and racial groups, but not between sex. Patients that were Black, >67 years old, and had low-income had a significantly less survival time than their corresponding contrasts independently. The mean survival (in days) for low income vs. high income was 779.5 vs. 945.9 (p<.0001). The differences remained significant in stratified analyses by cancer stage. In stage II PC, the mean survival (in days) for White vs. Black populations was 1134.9 days vs 472.2 days, and in stage IV PC the survival comparison was 770.2 days vs. 787.5 days between the same groups. Discussion Significant race, age and income disparities in survival exist in the state of Florida. These disparities are present even when stage is accounted for. Knowledge of health disparities statistics are not sufficient, and a targeted multi-stakeholder approach needs to be developed to improve survival outcomes of our patients. Limitations to this study include the racial demographic of “other” not having further description due to limited data availability through the clinical research network. Citation Format: Guettchina Telisnor, Alexander S. Lim, Zhongyue Zhang, XiangYang Lou, Ibrahim Nassour, Sherise C. Rogers. Pancreatic cancer survival disparities in Florida using a statewide database [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A076.
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