Impact of Sociodemographic Disparities and Insurance Status on Survival of Patients with Early-Onset Colorectal Cancer.
Impact of Sociodemographic Disparities and Insurance Status on Survival of Patients with Early-Onset Colorectal Cancer.
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DOI：
10.1002/onco.13908
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发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Raghavan D
中科院分区：
文献类型：
--
作者：
Salem ME;Puccini A;Trufan SJ;Sha W;Kadakia KC;Hartley ML;Musselwhite LW;Symanowski JT;Hwang JJ;Raghavan D
低社会经济地位（SES）与结直肠癌（CRC）患者的生存率较差有关;然而，SES对早发性CRC的影响仍未得到描述。回顾性分析了2004年至2016年期间国家癌症数据库（NCDB）的数据。我们将收入和教育结合起来，形成了社会经济地位的综合衡量标准。根据SES组，使用Logistic回归和χ 2检验来检查早发性CRC。生存率和考克斯比例风险模型比较了SES组之间的分期特异性总生存期（OS）。总共确定了30，903例早发性CRC患者，其中78.7%为白色; 14.5%为黑人。与高SES患者相比，低SES患者更可能是黑人（26.3% vs. 6.1%）或西班牙裔（25.3% vs. 10.5%），患有T4肿瘤（21.3%对17.8%）和/或N2疾病（13%对11.1%），并且在诊断时存在IV期疾病（32.8%对27.7%）（p <.0001，所有比较）。在所有疾病阶段，随着SES的增加，OS逐渐改善（p <0.001）。在IV期，低SES患者的5年生存率为13.9%，而高SES患者的5年生存率为21.7%。在多变量分析中，当调整所有混杂变量时，SES（低组与高组;调整后的风险比[HRadj]，1.35; 95%置信区间[CI]，1.26 - 1.46）对生存率有显著影响（p <.0001）。保险（非私人与私人; HRadj，1.38; 95% CI，1.31 - 1.44）介导了31%的SES对生存的影响。SES低的早发CRC患者结局最差。我们的数据表明，在实施改善早发性CRC患者早期发现和治疗的计划时，应考虑SES。低社会经济地位（SES）与结直肠癌（CRC）患者的生存率较差有关;然而，SES对早发性CRC的影响仍未得到描述。在这项对国家癌症数据库中30，903例早发性CRC患者的回顾性研究中，观察到IV期诊断的年发生率稳步增加。死亡风险随着社会经济地位的下降而增加。种族和保险状况是生存的独立预测因素。实施计划，以改善获得护理和早期诊断策略的年轻人，特别是那些低社会经济地位，是必要的。早发性结直肠癌（CRC）的发病率和死亡率正在上升。这篇文章详细介绍了社会经济状况和早发性结直肠癌年轻人的临床结局之间的关系。
Low socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early‐onset CRC remains undescribed. Retrospective analysis of data from the National Cancer Database (NCDB) between 2004 and 2016 was conducted. We combined income and education to form a composite measure of SES. Logistic regression and χ2 testing were used to examine early‐onset CRC according to SES group. Survival rates and Cox proportional hazards models compared stage‐specific overall survival (OS) between the SES groups. In total, 30,903 patients with early‐onset CRC were identified, of whom 78.7% were White; 14.5% were Black. Low SES compared with high SES patients were more likely to be Black (26.3% vs. 6.1%) or Hispanic (25.3% vs. 10.5%), have T4 tumors (21.3% vs. 17.8%) and/or N2 disease (13% vs. 11.1%), and present with stage IV disease (32.8% vs. 27.7%) at diagnosis (p < .0001, all comparisons). OS gradually improved with increasing SES at all disease stages (p < .001). In stage IV, the 5‐year survival rate was 13.9% vs. 21.7% for patients with low compared with high SES. In multivariable analysis, SES (low vs. high group; adjusted hazard ratio [HRadj], 1.35; 95% confidence interval [CI], 1.26–1.46) was found to have a significant effect on survival (p < .0001) when all of the confounding variables were adjusted. Insurance (not private vs. private; HRadj, 1.38; 95% CI, 1.31–1.44) mediates 31% of the SES effect on survival. Patients with early‐onset CRC with low SES had the worst outcomes. Our data suggest that SES should be considered when implementing programs to improve the early detection and treatment of patients with early‐onset CRC. Low socioeconomic status (SES) has been linked to worse survival in patients with colorectal cancer (CRC); however, the impact of SES on early‐onset CRC remains undescribed. In this retrospective study of 30,903 patients with early‐onset CRC in the National Cancer Database, a steady increase in the yearly rate of stage IV diagnosis at presentation was observed. The risk of death increased as socioeconomic status decreased. Race and insurance status were independent predictors for survival. Implementation of programs to improve access to care and early diagnostic strategies among younger adults, especially those with low SES, is warranted. The incidence of and mortality from early‐onset colorectal cancer (CRC) is on the rise. This article details the relationship between socioeconomic status and clinical outcomes of young adults with early‐onset CRC.
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影响因子：
16.9
作者：
Bailey CE;Hu CY;You YN;Bednarski BK;Rodriguez-Bigas MA;Skibber JM;Cantor SB;Chang GJ
通讯作者：
Chang GJ
影响因子：
3.7
作者：
Mallin, Katherine;Browner, Amanda;Nelson, Heidi
通讯作者：
Nelson, Heidi
影响因子：
10.3
作者：
Nogueira, Leticia;Chawla, Neetu;Yabroff, K. Robin
通讯作者：
Yabroff, K. Robin
影响因子：
5.8
作者：
Salem, Mohamed E.;Battaglin, Francesca;Lenz, Heinz-Josef
通讯作者：
Lenz, Heinz-Josef
DOI：
10.1111/j.2517-6161.1995.tb02031.x
发表时间：
1995-01-01
影响因子：
5.8
作者：
BENJAMINI, Y;HOCHBERG, Y
通讯作者：
HOCHBERG, Y