RetroSearch Browse

Home - News ( United States | United Kingdom | Italy | Germany ) - Football scores

Showing content from https://pubmed.ncbi.nlm.nih.gov/34919133/ below:

Neighborhood and Individual Socioeconomic Disadvantage and Survival Among Patients With Nonmetastatic Common Cancers

. 2021 Dec 1;4(12):e2139593. doi: 10.1001/jamanetworkopen.2021.39593. Neighborhood and Individual Socioeconomic Disadvantage and Survival Among Patients With Nonmetastatic Common Cancers

Affiliations

¹ Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
² Division of Research, Kaiser Permanente Northern California, Oakland, California.
³ Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, New Haven, Connecticut.
⁴ Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut.
⁵ Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus.
⁶ Hematology and Oncology Product Development, Genentech & Roche, South San Francisco, California.
⁷ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.

PMID: 34919133
PMCID: PMC8683967
DOI: 10.1001/jamanetworkopen.2021.39593

Item in Clipboard

Neighborhood and Individual Socioeconomic Disadvantage and Survival Among Patients With Nonmetastatic Common Cancers

En Cheng et al. JAMA Netw Open. 2021.

. 2021 Dec 1;4(12):e2139593. doi: 10.1001/jamanetworkopen.2021.39593. Affiliations

¹ Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
² Division of Research, Kaiser Permanente Northern California, Oakland, California.
³ Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale Cancer Center, New Haven, Connecticut.
⁴ Yale Cancer Center, Smilow Cancer Hospital, New Haven, Connecticut.
⁵ Division of Medical Oncology, Department of Internal Medicine, Ohio State University, Columbus.
⁶ Hematology and Oncology Product Development, Genentech & Roche, South San Francisco, California.
⁷ Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.

PMID: 34919133
PMCID: PMC8683967
DOI: 10.1001/jamanetworkopen.2021.39593

Item in Clipboard

Abstract

Importance: Disadvantaged neighborhood-level and individual-level socioeconomic status (SES) have each been associated with suboptimal cancer care and inferior outcomes. However, independent or synergistic associations between neighborhood and individual socioeconomic disadvantage have not been fully examined, and prior studies using simplistic neighborhood SES measures may not comprehensively assess multiple aspects of neighborhood SES.

Objective: To investigate the associations of neighborhood SES (using a validated comprehensive composite measure) and individual SES with survival among patients with nonmetastatic common cancers.

Design, setting, and participants: This prospective, population-based cohort study was derived from the Surveillance, Epidemiology, and End Results-Medicare database from January 1, 2008, through December 31, 2011, with follow-up ending on December 31, 2017. Participants included older patients (≥65 years) with breast, prostate, lung, or colorectal cancer.

Exposures: Neighborhood SES was measured using the area deprivation index (ADI; quintiles), a validated comprehensive composite measure of neighborhood SES. Individual SES was assessed by Medicare-Medicaid dual eligibility (yes vs no), a reliable indicator for patient-level low income.

Main outcomes and measures: The primary outcome was overall mortality, and the secondary outcome was cancer-specific mortality. Hazard ratios (HRs) for the associations of ADI and dual eligibility with overall and cancer-specific mortality were estimated via Cox proportional hazards regression. Statistical analyses were conducted from January 23 to April 15, 2021.

Results: A total of 96 978 patients were analyzed, including 25 968 with breast, 35 150 with prostate, 16 684 with lung, and 19 176 with colorectal cancer. Median age at diagnosis was 76 years (IQR, 71-81 years) for breast cancer, 73 years (IQR, 70-77 years) for prostate cancer, 76 years (IQR, 71-81 years) for lung cancer, and 78 years (IQR, 72-84 years) for colorectal cancer. Among lung and colorectal cancer patients, 8412 (50.4%) and 10 486 (54.7%), respectively, were female. The proportion of non-Hispanic White individuals among breast cancer patients was 83.7% (n = 21 725); prostate cancer, 76.8% (n = 27 001); lung cancer, 83.5% (n = 13 926); and colorectal cancer, 81.1% (n = 15 557). Neighborhood-level and individual-level SES were independently associated with overall mortality, and no interactions were detected. Compared with the most affluent neighborhoods (ADI quintile 1), living in the most disadvantaged neighborhoods (ADI quintile 5) was associated with higher risk of overall mortality (breast: HR, 1.34; 95% CI, 1.26-1.43; prostate: HR, 1.51; 95% CI, 1.42-1.62; lung: HR, 1.21; 95% CI, 1.14-1.28; and colorectal: HR, 1.24; 95% CI, 1.17-1.32). Individual socioeconomic disadvantage (dual eligibility) was associated with higher risk of overall mortality (breast: HR, 1.22; 95% CI, 1.15-1.29; prostate: HR, 1.29; 95% CI, 1.21-1.38; lung: HR, 1.14; 95% CI, 1.09-1.20; and colorectal: HR, 1.23; 95% CI, 1.17-1.29). A similar pattern was observed for cancer-specific mortality.

Conclusions and relevance: In this cohort study, neighborhood-level deprivation was associated with worse survival among patients with nonmetastatic breast, prostate, lung, and colorectal cancer, even after accounting for individual SES. These findings suggest that, in order to improve cancer outcomes and reduce health disparities, policies for ongoing investments in low-resource neighborhoods and low-income households are needed.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Fuchs reported serving as a consultant for Agios, Amylin Pharmaceuticals, AstraZeneca, Bain Capital, CytomX Therapeutics, Daiichi-Sankyo, Eli Lilly, Entrinsic Health, Evolveimmune Therapeutics, Genentech, Merck, Taiho, and Unum Therapeutics; serving as a director for CytomX Therapeutics; owning unexercised stock options for CytomX and Entrinsic Health; being a cofounder of Evolveimmune Therapeutics, with equity in this private company; and providing expert testimony for Amylin Pharmaceuticals and Eli Lilly. Dr Meyerhardt reported receiving institutional research funding from Boston Biomedical and serving as an advisor/consultant to Ignyta, Taiho, and Cota. Dr Gross reported receiving research funding through Yale University from the National Comprehensive Cancer Network Foundation (Pfizer and AstraZeneca), Johnson & Johnson, and Genentech; and reimbursement from Flatiron as a speaker. Ms Soulos reported receiving personal fees from Target PharmaSolutions outside the submitted work. No other disclosures were reported.

Figures
Figure 1.. Kaplan-Meier Estimates for Overall Survival…

Figure 1.. Kaplan-Meier Estimates for Overall Survival by Quintiles of Area Deprivation Index for Patients…
Figure 1.. Kaplan-Meier Estimates for Overall Survival by Quintiles of Area Deprivation Index for Patients With Breast, Prostate, Lung, and Colorectal Cancer

Overall survival by quintiles of ADI for breast (n = 25 968), prostate (n = 35 150), lung (n = 16 684), and colorectal cancer (n = 19 176). P values for each cancer were calculated using the log-rank test, and all were significant (P < .001). ADI indicates Area Deprivation Index.

Figure 2.. Associations Between Area Deprivation and…

Figure 2.. Associations Between Area Deprivation and Mortality According to Dual Eligibility Status (Yes vs…
Figure 2.. Associations Between Area Deprivation and Mortality According to Dual Eligibility Status (Yes vs No) by Cancer Types

Adjusted for age, sex, race and ethnicity, marital status, cancer stage, Elixhauser comorbidity index, surgery, radiotherapy, and chemotherapy. Area Deprivation Index (ADI) and Medicare-Medicaid dual eligibility (DE) were mutually adjusted, and the interaction term ADI*DE was also included. For breast cancer, hormone receptor status was additionally adjusted. For prostate cancer, androgen deprivation therapy was additionally adjusted. P value for interaction was assessed using likelihood-ratio tests. ADI was evaluated as an ordinal variable, and each level (quintile) corresponded to the equivalent integer (from 1 through 5). CRC, colorectal cancer; HR, hazard ratio.