Treatment and survival disparities in lung cancer: The effect of social environment and place of residence
Treatment and survival disparities in lung cancer: The effect of social environment and place of residence
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DOI：
10.1016/j.lungcan.2014.01.008
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发表时间：
2014-03-01
期刊：
影响因子：
5.3
通讯作者：
Bayakly, A. Rana
中科院分区：
文献类型：
--
作者：
Johnson, Asal Mohamadi;Hines, Robert B.;Bayakly, A. Rana
目的：本研究的目的是测量地理居住状况和社会环境与诊断为非小细胞肺癌（NSCLC）患者的疾病分期、接受治疗和5年生存率的关系程度。方法和材料：本研究是对乔治亚州综合癌症登记处（GCCR）诊断的非小细胞肺癌病例的回顾性队列研究。5个结果变量采用多水平logistic模型：诊断时未分期和晚期疾病；接受治疗（手术、化疗和放疗）；以及诊断后的存活率。感兴趣的社会和地理变量为人口普查区（CT）贫困水平、CT水平教育程度和CT水平地理居住状况。结果：与。城市居民、农村和郊区居民患未分期疾病的几率增加（郊区OR= 1.23, 95% CI: 1.11-1.37；农村OR= 1.63, 95% CI: 1.45-1.83）。在本研究中，农村参与者接受放疗（OR= 0.89, 95% Cl: 0.82-0.96）和化疗（OR= 0.92,95% CI: 0.85-0.99）的几率较低。生活在教育水平较低的ct区，接受手术（最低教育水平OR= 0.67, 95% CI: 0.59-0.75）和化疗（最低教育水平OR= 0.74, 95% CI: 0.68-0.81）的几率降低。生活在贫困程度较高的地区（高贫困程度HR= 1.04,95% CI: 1.01-1.09）和教育程度较低的地区（最低教育程度HR= 1.12, 95% CI: 1.07-1.17）与较差的生存率相关。在控制治疗的情况下，农村居民并没有表现出较差的生存，甚至早期疾病的死亡风险也较低（HR= 0.90, 95% Cl: 0.82-0.99）。结论：本研究得出结论，NSCLC患者的居住地在一定程度上可以解释治疗和预后差异。公共卫生从业人员和政策制定者应认识到人们居住地的重要性，并将努力转向改善农村地区和集中贫困社区的肺癌预后。2014爱思唯尔爱尔兰有限公司版权所有。
Objective: The purpose of this study was to measure the extent to which geographic residency status and the social environment are associated with disease stage at diagnosis, receipt of treatment, and five-year survival for patients-diagnosed with non-small cell lung cancer (NSCLC).Methods and materials: This study was a retrospective cohort study of the Georgia Comprehensive Cancer Registry (GCCR) for incident cases of NSCLC diagnosed in the state. Multilevel logistic models were employed for five outcome variables: unstaged and late stage disease at diagnosis; receipt of treatment (surgery, chemotherapy, and radiation); and survival following diagnosis. The social and geographical variables of interest were census tract (CT) poverty level, CT-level educational attainment, and CT-level geographic residency status.Results: Compared to. urban residents, rural and suburban residents had increased odds of unstaged disease (suburban OR= 1.23, 95% CI: 1.11-1.37; rural OR= 1.63, 95% CI: 1.45-1.83). In this study, rural participants had lower odds of receiving radiotherapy (OR= 0.89, 95% Cl: 0.82-0.96) and chemotherapy (OR= 0.92,95% CI: 0.85-0.99). Living in CTs with lower educational levels was associated with decreasing odds of receiving both surgery (lowest educational level OR= 0.67, 95% CI: 0.59-0.75) and chemotherapy (lowest educational level OR= 0.74, 95% CI: 0.68-0.81). Living in areas with higher concentration of deprivation (high level of deprivation HR= 1.04,95% CI: 1.01-1.09) and lower levels of education (lowest educational level HR= 1.12, 95% CI: 1.07-1.17) was associated with poorer survival. Rural residents did not show poorer survival when treatment was controlled and they even presented a lower risk of death for early stage disease (HR= 0.90, 95% Cl: 0.82-0.99).Conclusion: This study concludes that where NSCLC patients live can, to some extent, explain treatment and prognostic disparities. Public health practitioners and policy makers should be cognizant of the importance of where people live and shift their efforts to improve lung cancer outcomes in rural areas and neighborhoods with concentrated poverty. (C) 2014 Elsevier Ireland Ltd. All rights reserved.