Evaluating the Impact of Social and Built Environments on Health-Related Quality of Life among Cancer Survivors.
Evaluating the Impact of Social and Built Environments on Health-Related Quality of Life among Cancer Survivors.
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DOI：
10.1158/1055-9965.epi-21-0129
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发表时间：
2022-01
期刊：
影响因子：
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通讯作者：
Shariff-Marco S
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文献类型：
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作者：
Chu JN;Canchola AJ;Keegan THM;Nickell A;Oakley-Girvan I;Hamilton AS;Yu RL;Gomez SL;Shariff-Marco S
美国有近1700万癌症幸存者，了解影响健康相关生活质量（HRQOL）的多层次因素对改善生存结局至关重要。很少有研究评估癌症幸存者的HRQOL邻里的影响。我们结合了来自加州三项基于登记研究的社会人口统计学、临床和行为数据。使用3级混合线性回归模型（参与者嵌套在块组和研究/区域），我们研究了独立的邻里属性和邻里原型，捕捉邻里属性之间固有的相互作用，与两个HRQOL结果，身体（PCS）和精神（MCS）的综合评分的关联。在2,477名幸存者中，46%为70岁以上，52%为非西班牙裔白色人，53%患有局部疾病。在对年龄、分期和癌症复发进行最小调整的模型中，HRQOL与社区社会经济地位（nSES）、种族/民族组成、人口密度、街道连通性、餐馆环境指数、交通密度、城市化程度、拥挤程度、出租物业和非单一家庭单位相关。在完全调整后的模型中，较高的nSES与较好的PCS相关，餐厅环境指数，特别是更不健康的餐厅，与更差的MCS相关。在邻里原型的多变量调整模型中，与中上阶层郊区相比，西班牙裔小城镇和内城的PCS较低，高地位的MCS较高。在幸存者中，较高的nSES与较好的HRQOL相关;更多不健康的餐馆与较差的HQROL相关。由于一些邻里原型与HRQOL相关，它们提供了一种方法来捕捉邻里属性如何相互作用，以影响HRQOL。阐明邻里属性影响HRQOL的途径对改善生存结局很重要。
With almost 17 million U.S. cancer survivors, understanding multilevel factors impacting health-related quality of life (HRQOL) is critical to improving survivorship outcomes. Few studies have evaluated neighborhood impact on HRQOL among cancer survivors. We combined sociodemographic, clinical, and behavioral data from three registry-based studies in California. Using a 3-level mixed linear regression model (participants nested within block groups and study/regions) we examined associations of both independent neighborhood attributes and neighborhood archetypes, which capture interactions inherent among neighborhood attributes, with two HRQOL outcomes, physical (PCS) and mental (MCS) composite scores. For the 2,477 survivors, 46% were 70+ years, 52% were non-Hispanic White, and 53% had localized disease. In models minimally adjusted for age, stage, and cancer recurrence, HRQOL was associated with neighborhood socioeconomic status (nSES), racial/ethnic composition, population density, street connectivity, restaurant environment index, traffic density, urbanicity, crowding, rental properties, and non-single family units. In fully adjusted models, higher nSES remained associated with better PCS, and restaurant environment index, specifically more unhealthy restaurants, associated with worse MCS. In multivariable-adjusted models of neighborhood archetype, compared to Upper middle-class suburb, Hispanic small town, and Inner city had lower PCS, and High status had higher MCS. Among survivors, higher nSES was associated with better HRQOL; more unhealthy restaurants were associated with worse HQROL. As some neighborhood archetypes were associated with HRQOL, they provide an approach to capture how neighborhood attributes interact to impact HRQOL. Elucidating the pathways through which neighborhood attributes influence HRQOL is important in improving survivorship outcomes.