Neighborhood and Individual Socioeconomic Disadvantage and Survival Among Patients With Nonmetastatic Common Cancers.
Neighborhood and Individual Socioeconomic Disadvantage and Survival Among Patients With Nonmetastatic Common Cancers.
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非转移性普通癌症患者的邻居和个人社会经济劣势和生存率。
DOI：
10.1001/jamanetworkopen.2021.39593
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发表时间：
2021-12-01
影响因子：
13.8
通讯作者：
Gross CP
中科院分区：
文献类型：
--
作者：
Cheng E;Soulos PR;Irwin ML;Cespedes Feliciano EM;Presley CJ;Fuchs CS;Meyerhardt JA;Gross CP
考虑到个人的社会经济劣势后，生活在贫困社区是否与癌症诊断后较差的生存率相关？在这项对 96-978 名患有非转移性乳腺癌、前列腺癌、肺癌和结直肠癌的老年患者进行的队列研究中，即使在对患者水平的低收入进行调整后，社区水平的劣势也与较差的生存率相关。这些发现表明，为了改善癌症结果并减少健康差距，需要制定针对资源匮乏社区和低收入家庭持续投资的政策。这项队列研究探讨了社区和个人社会经济劣势与患有非转移性常见癌症的老年患者的生存率之间的关系。弱势社区层面和个人层面的社会经济地位（SES）均与次优的癌症护理和较差的结果相关。然而，邻里与个人社会经济劣势之间的独立或协同关联尚未得到充分检验，并且先前使用简单化邻里SES措施的研究可能无法全面评估邻里SES的多个方面。旨在调查邻近 SES（使用经过验证的综合综合测量）和个体 SES 与非转移性常见癌症患者生存的关联。这项基于人群的前瞻性队列研究源自 2008 年 1 月 1 日至 2011 年 12 月 31 日的监测、流行病学和最终结果 - 医疗保险数据库，随访截至 2017 年 12 月 31 日。参与者包括患有乳腺癌、前列腺癌、肺癌或结直肠癌的老年患者（≥65 岁）。社区社会经济地位是使用面积剥夺指数（ADI；五分位数）来衡量的，这是一种经过验证的社区社会经济地位综合综合衡量指标。个人社会经济地位通过医疗保险-医疗补助双重资格（是与否）进行评估，这是患者低收入水平的可靠指标。主要结局是总体死亡率，次要结局是癌症特异性死亡率。通过 Cox 比例风险回归估计 ADI 和双重资格与总体死亡率和癌症特异性死亡率之间的关联风险比 (HR)。统计分析时间为2021年1月23日至4月15日。共分析96±978例患者，其中乳腺癌患者25±968例，前列腺癌35±150例，肺癌16±684例，结直肠癌19±176例。乳腺癌诊断时的中位年龄为 76 岁（IQR，71-81 岁），前列腺癌为 73 岁（IQR，70-77 岁），肺癌为 76 岁（IQR，71-81 岁），结直肠癌为 78 岁（IQR，72-84 岁）。肺癌和结直肠癌患者中，女性分别为 8412 例（50.4%）和 10 486 例（54.7%）。乳腺癌患者中非西班牙裔白人的比例为 83.7% (n = 21 725)；前列腺癌，76.8% (n = 27 001)；肺癌，83.5% (n = 13 926)；和结直肠癌，81.1% (n = 15 557)。社区层面和个人层面的 SES 与总体死亡率独立相关，并且没有检测到交互作用。与最富裕的社区（ADI 五分位数 1）相比，生活在最贫困的社区（ADI 五分位数 5）与较高的总体死亡率风险相关（乳腺癌：HR，1.34；95% CI，1.26-1.43；前列腺：HR，1.51；95% CI，1.42-1.62；肺：HR，1.21；95% CI，1.42-1.62；肺部：HR，1.21；95% CI，1.26-1.43）。 1.14-1.28；结肠直肠：HR，1.24；95% CI，1.17-1.32）。个人社会经济劣势（双重资格）与较高的总体死亡率风险相关（乳腺癌：HR，1.22；95% CI，1.15-1.29；前列腺：HR，1.29；95% CI，1.21-1.38；肺：HR，1.14；95% CI，1.09-1.20；结直肠癌：HR，1.23； 95% CI，1.17-1.29）。癌症特异性死亡率也观察到类似的模式。在这项队列研究中，即使在考虑了个体 SES 后，邻里层面的剥夺也与非转移性乳腺癌、前列腺癌、肺癌和结直肠癌患者的较差生存率相关。这些发现表明，为了改善癌症结果并减少健康差距，需要制定针对资源匮乏社区和低收入家庭持续投资的政策。
After accounting for individual socioeconomic disadvantage, is living in a deprived neighborhood associated with worse survival after cancer diagnosis? In this cohort study of 96 978 older patients with nonmetastatic breast, prostate, lung, and colorectal cancers, neighborhood-level disadvantage was associated with worse survival even after adjusting for patient-level low income. These findings suggest that in order to improve cancer outcomes and reduce health disparities, policies for ongoing investments in low-resource neighborhoods and low-income households are needed. This cohort study examines the association of neighborhood and individual socioeconomic disadvantage with survival among older patients with nonmetastatic common cancers. Disadvantaged neighborhood-level and individual-level socioeconomic status (SES) have each been associated with suboptimal cancer care and inferior outcomes. However, independent or synergistic associations between neighborhood and individual socioeconomic disadvantage have not been fully examined, and prior studies using simplistic neighborhood SES measures may not comprehensively assess multiple aspects of neighborhood SES. To investigate the associations of neighborhood SES (using a validated comprehensive composite measure) and individual SES with survival among patients with nonmetastatic common cancers. This prospective, population-based cohort study was derived from the Surveillance, Epidemiology, and End Results–Medicare database from January 1, 2008, through December 31, 2011, with follow-up ending on December 31, 2017. Participants included older patients (≥65 years) with breast, prostate, lung, or colorectal cancer. Neighborhood SES was measured using the area deprivation index (ADI; quintiles), a validated comprehensive composite measure of neighborhood SES. Individual SES was assessed by Medicare-Medicaid dual eligibility (yes vs no), a reliable indicator for patient-level low income. The primary outcome was overall mortality, and the secondary outcome was cancer-specific mortality. Hazard ratios (HRs) for the associations of ADI and dual eligibility with overall and cancer-specific mortality were estimated via Cox proportional hazards regression. Statistical analyses were conducted from January 23 to April 15, 2021. A total of 96 978 patients were analyzed, including 25 968 with breast, 35 150 with prostate, 16 684 with lung, and 19 176 with colorectal cancer. Median age at diagnosis was 76 years (IQR, 71-81 years) for breast cancer, 73 years (IQR, 70-77 years) for prostate cancer, 76 years (IQR, 71-81 years) for lung cancer, and 78 years (IQR, 72-84 years) for colorectal cancer. Among lung and colorectal cancer patients, 8412 (50.4%) and 10 486 (54.7%), respectively, were female. The proportion of non-Hispanic White individuals among breast cancer patients was 83.7% (n = 21 725); prostate cancer, 76.8% (n = 27 001); lung cancer, 83.5% (n = 13 926); and colorectal cancer, 81.1% (n = 15 557). Neighborhood-level and individual-level SES were independently associated with overall mortality, and no interactions were detected. Compared with the most affluent neighborhoods (ADI quintile 1), living in the most disadvantaged neighborhoods (ADI quintile 5) was associated with higher risk of overall mortality (breast: HR, 1.34; 95% CI, 1.26-1.43; prostate: HR, 1.51; 95% CI, 1.42-1.62; lung: HR, 1.21; 95% CI, 1.14-1.28; and colorectal: HR, 1.24; 95% CI, 1.17-1.32). Individual socioeconomic disadvantage (dual eligibility) was associated with higher risk of overall mortality (breast: HR, 1.22; 95% CI, 1.15-1.29; prostate: HR, 1.29; 95% CI, 1.21-1.38; lung: HR, 1.14; 95% CI, 1.09-1.20; and colorectal: HR, 1.23; 95% CI, 1.17-1.29). A similar pattern was observed for cancer-specific mortality. In this cohort study, neighborhood-level deprivation was associated with worse survival among patients with nonmetastatic breast, prostate, lung, and colorectal cancer, even after accounting for individual SES. These findings suggest that, in order to improve cancer outcomes and reduce health disparities, policies for ongoing investments in low-resource neighborhoods and low-income households are needed.
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影响因子：
6.2
作者：
Doll, Kemi M.;Meng, Ke;Meyer, Anne-Marie
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作者：
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