Influence of Comorbidity Burden, Socioeconomic Status, and Race and Ethnicity on Survival Disparities in Patients With Cancer.
Influence of Comorbidity Burden, Socioeconomic Status, and Race and Ethnicity on Survival Disparities in Patients With Cancer.
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DOI：
10.1177/10732748231204474
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发表时间：
2023-01
期刊：
影响因子：
2.6
通讯作者：
Haque, Reina
中科院分区：
文献类型：
--
作者：
Cooper, Robert M.;Chao, Chun;Mukherjee, Amrita;Zhuang, Zimin;Haque, Reina
关键词：
本研究的目的是评估合并症负担与总体生存率的关系，解释癌症患者的种族/民族和社会经济差异。在这项回顾性队列研究中，从南加州的一项大型健康计划中确定了 2010 年至 2018 年间新诊断出癌症的患者。癌症登记数据与电子健康记录（EHR）相关联。合并症负担由 Elixhauser 合并症指数 (ECI) 定义。对患者进行随访至 2019 年 12 月，以评估全因死亡率。使用 Cox 比例风险模型评估合并症负担与全因死亡率的关联。确定了粗略和调整后的风险比（HR，95%CI）。在分析中纳入的 153,270 名患者中，29% 在随后的 10 年随访期间死亡。近 49% 是有色人种患者，32% 的 ECI > 4。在调整年龄、性别、种族/民族、癌症分期、吸烟状况、保险支付人、医疗中心、癌症诊断年份和癌症治疗后，我们观察到一种趋势，表明社会经济地位 (SES) 降低会导致更高的死亡风险（P 趋势<.05）。与SES最高五分位的患者相比，最低、第二低、中间和第二高五分位的患者的死亡风险分别高出25%、21%、18%和11%[（HR，95%CI）：1.25（1.21-1.29）、1.21（1.18-1.25）、1.18 （1.15-1.22）和1.11（1.07-1.14）]。当我们另外调整 ECI 时，SES 的调整后 HR 略有减弱；然而，这种趋势仍然存在。在调整后的模型中，与 ECI 评分 = 0 的患者相比，合并症负担较高的患者具有较高的死亡风险 [(HR，95%CI)：1.22 (1.17-1.28)、1.48 (1.42-1.55)、1.80 (1.72-1.89)、2.24 (2.14-2.34) 和 3.39 (3.25-3.53) 分别为 ECI = 1、2、3、4 和 >5]。无论种族/民族和社会经济地位有何差异，合并症负担都会影响癌症患者的总体生存率。减少合并症负担可以降低部分（但不是全部）与较低 SES 相关的死亡风险。
The purpose of this study was to assess the association of comorbidity burden with overall survival, accounting for racial/ethnic and socioeconomic differences in patients with cancer. In this retrospective cohort study, patients newly diagnosed with cancer between 2010 and 2018 were identified from a large health plan in southern California. Cancer registry data were linked with electronic health records (EHR). Comorbidity burden was defined by the Elixhauser comorbidity index (ECI). Patients were followed through December 2019 to assess all-cause mortality. Association of comorbidity burden with all-cause mortality was evaluated using Cox proportional hazards model. Crude and adjusted hazard ratio (HR, 95%CI) were determined. Of 153,270 patients included in the analysis, 29% died during the ensuing 10-year follow-up. Nearly 49% were patients of color, and 32% had an ECI > 4. After adjusting for age, sex, race/ethnicity, cancer stage, smoking status, insurance payor, medical center, year of cancer diagnosis, and cancer treatments, we observed a trend demonstrating higher mortality risk by decreasing socioeconomic status (SES) (P-trend<.05). Compared to patients in the highest SES quintile, patients in the lowest, second lowest, middle, and second highest quintiles had 25%, 21%, 18%, and 11% higher risk of mortality, respectively [(HR, 95%CI): 1.25 (1.21-1.29), 1.21 (1.18-1.25), 1.18 (1.15-1.22), and 1.11 (1.07-1.14), respectively]. When we additionally adjusted for ECI, the adjusted HRs for SES were slightly attenuated; however, the trend persisted. Patients with higher comorbidity burden had higher mortality risk compared to patients with ECI score = 0 in the adjusted model [(HR, 95%CI): 1.22 (1.17-1.28), 1.48 (1.42-1.55), 1.80 (1.72-1.89), 2.24 (2.14-2.34), and 3.39 (3.25-3.53) for ECI = 1, 2, 3, 4, and >5, respectively]. Comorbidity burden affects overall survival in cancer patients irrespective of racial/ethnic and SES differences. Reducing comorbidity burden can reduce some, but not all, of the mortality risk associated with lower SES.
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DOI：
10.1037/hea0000242
发表时间：
2016-04
期刊：
Health psychology : official journal of the Division of Health Psychology, American Psychological Association
影响因子：
--
作者：
Williams DR;Priest N;Anderson NB
通讯作者：
Anderson NB
影响因子：
4.7
作者：
Morishima T;Matsumoto Y;Koeda N;Shimada H;Maruhama T;Matsuki D;Nakata K;Ito Y;Tabuchi T;Miyashiro I
通讯作者：
Miyashiro I
影响因子：
2.5
作者：
Singh S;Sridhar P
通讯作者：
Sridhar P
影响因子：
3.9
作者：
Søgaard M;Thomsen RW;Bossen KS;Sørensen HT;Nørgaard M
通讯作者：
Nørgaard M
影响因子：
3
作者：
Thompson NR;Fan Y;Dalton JE;Jehi L;Rosenbaum BP;Vadera S;Griffith SD
通讯作者：
Griffith SD