Sociodemographic disparities in the occurrence of medical conditions among adolescent and young adult Hodgkin lymphoma survivors
Sociodemographic disparities in the occurrence of medical conditions among adolescent and young adult Hodgkin lymphoma survivors
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DOI：
10.1007/s10552-018-1025-0
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发表时间：
2018-06-01
影响因子：
2.3
通讯作者：
Wun, Ted
中科院分区：
文献类型：
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作者：
Keegan, Theresa H. M.;Li, Qian;Wun, Ted
霍奇金淋巴瘤(HL)幸存者罹患第二次癌症和心血管疾病的风险很高，但还没有研究考虑青少年和年轻成人(Aya)幸存者中这些和其他医疗条件的发生是否因社会人口学因素而不同。1996年至2012年期间，5,085名年龄在15-39岁之间的HL患者被诊断为HL，并存活2年，数据来自加利福尼亚州癌症登记中心，并与住院数据相关联。我们使用多变量Cox比例风险回归分析了种族/民族、邻里社会经济状况(SES)和医疗保险对疾病(确诊后2年)发生的影响以及医疗条件对生存的影响。26%的AYA在治疗HL后经历了至少一种医疗条件，15%的人有两种医疗条件。在多变量分析中，黑人HL幸存者与非西班牙裔白人相比，有更高的内分泌[危险比(HR)=1.37，95%可信区间(CI)1.05-1.78]和循环系统疾病(HR=1.58，CI 1.17-2.14)的可能性；拉美裔患者患内分泌疾病的可能性更高[HR=1.24(1.04-1.48)]。有公共保险或没有保险的AYA(与私人/军队相比)患循环系统疾病、呼吸系统疾病、慢性肾脏疾病/肾功能衰竭、肝脏疾病和内分泌疾病的可能性更高。居住在低SES社区的Ayas(与高SES社区相比)有更高的呼吸系统和内分泌疾病的可能性。患有这些疾病或第二癌症的AYAS患者的死亡风险增加了两倍以上。改善AYA HL幸存者的医疗保健利用情况以进行监测和二级预防的策略可能会改善预后。
Hodgkin lymphoma (HL) survivors experience high risks of second cancers and cardiovascular disease, but no studies have considered whether the occurrence of these and other medical conditions differ by sociodemographic factors in adolescent and young adult (AYA) survivors.Data for 5,085 patients aged 15-39 when diagnosed with HL during 1996-2012 and surviving >= 2 years were obtained from the California Cancer Registry and linked to hospitalization data. We examined the impact of race/ethnicity, neighborhood socioeconomic status (SES), and health insurance on the occurrence of medical conditions (>= 2 years after diagnosis) and the impact of medical conditions on survival using multivariable Cox proportional hazards regression.Twenty-six percent of AYAs experienced at least one medical condition and 15% had >= 2 medical conditions after treatment for HL. In multivariable analyses, Black HL survivors had a higher likelihood (vs. non-Hispanic Whites) of endocrine [hazard ratio (HR) = 1.37, 95% confidence interval (CI) 1.05-1.78] and circulatory system diseases (HR = 1.58, CI 1.17-2.14); Hispanics had a higher likelihood of endocrine diseases [HR = 1.24 (1.04-1.48)]. AYAs with public or no insurance (vs. private/military) had higher likelihood of circulatory system diseases, respiratory system diseases, chronic kidney disease/renal failure, liver disease, and endocrine diseases. AYAs residing in low SES neighborhoods (vs. high) had higher likelihood of respiratory system and endocrine diseases. AYAs with these medical conditions or second cancers had an over twofold increased risk of death.Strategies to improve health care utilization for surveillance and secondary prevention among AYA HL survivors at increased risk of medical conditions may improve outcomes.