Socioeconomic Disparities in Brain Metastasis Survival and Treatment: A Population-Based Study.
Socioeconomic Disparities in Brain Metastasis Survival and Treatment: A Population-Based Study.
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DOI：
10.1016/j.wneu.2021.11.036
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发表时间：
2022-03
影响因子：
2
通讯作者：
Hayden-Gephart, Melanie
中科院分区：
文献类型：
--
作者：
Rodrigues, Adrian;Li, Guan;Bhambhvani, Hriday;Hayden-Gephart, Melanie
在本研究中，我们使用了经过验证的社会经济地位（SES）指数和基于人群的登记来确定和量化SES对诊断为同步脑转移的患者获得治疗和总体生存的影响。监测、流行病学和最终结果数据库用于提取2010年至2016年间首次出现脑转移的所有患者。使用经过验证的Yost指数将SES分为四分位数和五分位数。采用多变量logistic回归来评估人口统计学、肿瘤和社会经济协变量对接受放疗和化疗的影响。Kaplan-Meier曲线用于估计生存率。在2010年至2016年期间，35,595名患者在原发性癌症诊断时出现脑转移。大多数患者在最初的治疗过程中接受了放疗和/或化疗；71.6% （n = 25,484）接受放疗，54.4% （n = 19,371）接受化疗，44.9% （n = 15,984）接受放化疗。Yost最高五分位数和最高五分位数的患者总生存期更长（P < 0.001）。此外，多变量logistic回归显示，最低Yost五分位数的患者接受放疗（校正OR: 0.82； 95%可信区间：0.75-0.89;P < 0.001）或化疗（校正OR: 0.62； 95%可信区间：0.58-0.67;P < 0.001）的可能性显著降低。在一项针对脑转移患者的大规模人群分析中，我们发现不同社会经济阶层在治疗可及性和轻度生存差异方面存在显著差异。更具体地说，即使在考虑了其他肿瘤和人口统计学相关信息后，较低社会经济等级的患者的预后更差，接受放疗和化疗的频率也低于较高社会经济等级的患者。
In the present study, we used a validated socioeconomic status (SES) index and population-based registry to identify and quantify the impact of SES on access to treatment and overall survival for patients diagnosed with synchronous brain metastases. The Surveillance, Epidemiology, and End Results database was used to extract all patients between 2010 and 2016 with brain metastases at initial presentation. SES was stratified into tertiles and quintiles using the validated Yost index. Multivariable logistic regressions were used to evaluate the impact of demographic, tumor, and socioeconomic covariates on receipt of radiotherapy and chemotherapy. Kaplan-Meier curves were used to estimate survival. Between 2010 and 2016, 35,595 patients presented with brain metastases at the time of primary cancer diagnosis. Most patients received radiation and/or chemotherapy as part of the initial course of their treatment; 71.6% (n = 25,484) were irradiated while 54.4% (n = 19,371) received chemotherapy and 44.9% (n = 15,984) received chemoradiation. Patients in the highest Yost tertile and quintile experienced longer overall survival (P < 0.001). Additionally, multivariable logistic regression revealed that the lowest Yost quintile was significantly less likely to receive either radiation (adjusted OR: 0.82; 95% confidence interval: 0.75–0.89; P < 0.001) or chemotherapy (adjusted OR: 0.62; 95% confidence interval: 0.58–0.67; P < 0.001). In a large, population-based analysis of brain metastasis patients, we found significant differences in treatment access and mild survival differences along socioeconomic strata. More specifically, patients in lower SES tiers suffered worse outcomes and received radiation and chemotherapy less frequently than patients in higher tiers, even after accounting for other tumor- and demographic-related information.
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影响因子：
2.6
作者：
Park, Henry S;Lloyd, Shane;Yu, James B
通讯作者：
Yu, James B
DOI：
10.1016/j.ijrobp.2009.08.025
发表时间：
2010-07-01
影响因子：
7
作者：
Sperduto, Paul W.;Chao, Samuel T.;Mehta, Minesh
通讯作者：
Mehta, Minesh
影响因子：
2.1
作者：
Aarts, Mieke J.;Koldewijn, Evert L.;Louwman, Marieke
通讯作者：
Louwman, Marieke
影响因子：
3.9
作者：
Bhambhvani, Hriday P.;Rodrigues, Adrian J.;Gephart, Melanie Hayden
通讯作者：
Gephart, Melanie Hayden
影响因子：
3.4
作者：
Boscoe, Francis P.;Liu, Bian;Lee, Furrina
通讯作者：
Lee, Furrina