Effects of marital status and economic resources on survival after cancer: A population-based study.
Effects of marital status and economic resources on survival after cancer: A population-based study.
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DOI：
10.1002/cncr.29885
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发表时间：
2016-05-15
期刊：
影响因子：
6.2
通讯作者：
Martínez ME
中科院分区：
文献类型：
--
作者：
Gomez SL;Hurley S;Canchola AJ;Keegan TH;Cheng I;Murphy JD;Clarke CA;Glaser SL;Martínez ME
虽然已婚癌症患者比未婚患者的生存率更高，但这种关联的原因尚不完全清楚。作者在一个大型的加州队列中评估了经济资源的作用，包括健康保险状况和社区社会经济地位（nSES）。从加州癌症登记处，我们确定了783，167名癌症患者（386，607例死亡），他们在2000年至2009年期间被诊断为每个性别的10个最常见的癌症相关死亡部位中的第一个原发性浸润性癌症，并随访至2012年。采用分层和阶段分层的考克斯比例风险模型估计与婚姻状况相关的全因死亡率的风险比（HR）和95%置信区间（95% CI），并根据癌症部位、人种/种族和治疗进行校正。与已婚患者相比，未婚患者的死亡风险升高，男性（HR，1.27; 95% CI，1.26-1.29）高于女性（HR，1.19; 95% CI，1.18-1.20; P <0.001）。保险状况和nSES的调整降低了婚姻状况的HR为1.22男性和1.15女性。有证据表明婚姻状况、保险和nSES存在协同效应，与那些保险不足和生活在低nSES地区的人相比，在保险不足和生活在高nSES地区的人中，未婚状况的风险相对较高（男性P交互= 6.8 × 10−9，女性P交互= 8.2 × 10−8）。未婚癌症患者的生存率低于已婚癌症患者，这似乎与经济资源的差异关系不大。
Although married cancer patients have more favorable survival than unmarried patients, reasons underlying this association are not fully understood. The authors evaluated the role of economic resources, including health insurance status and neighborhood socioeconomic status (nSES), in a large California cohort. From the California Cancer Registry, we identified 783,167 cancer patients (386,607 deaths) who were diagnosed during 2000 through 2009 with a first primary, invasive cancer of the 10 most common sites of cancer-related death for each sex and were followed through 2012. Age-stratified and stage-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality associated with marital status, adjusted for cancer site, race/ethnicity, and treatment. Compared with married patients, unmarried patients had an elevated risk of mortality that was higher among males (HR, 1.27; 95% CI, 1.26–1.29) than among females (HR, 1.19; 95% CI, 1.18–1.20; Pinteraction < .001). Adjustment for insurance status and nSES reduced the marital status HRs to 1.22 for males and 1.15 for females. There was some evidence of synergistic effects of marital status, insurance, and nSES, with relatively higher risks observed for unmarried status among those who were under-insured and living in high nSES areas compared with those who were under-insured and living in low nSES areas (Pinteraction = 6.8 × 10−9 among males and 8.2 × 10−8 among females). The worse survival of unmarried than married cancer patients appears to be minimally explained by differences in economic resources.
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影响因子：
3.3
作者：
Turner-Cobb, JM;Sephton, SE;Spiegel, D
通讯作者：
Spiegel, D
影响因子：
5.4
作者：
UMBERSON, D
通讯作者：
UMBERSON, D
影响因子：
5.4
作者：
Kravdal, O
通讯作者：
Kravdal, O
影响因子：
4.5
作者：
Sammon, Jesse D.;Morgan, Monica;Karakiewicz, Pierre I.
通讯作者：
Karakiewicz, Pierre I.
影响因子：
5.6
作者：
Jaffe, Dena H.;Manor, Orly;Neumark, Yehuda D.
通讯作者：
Neumark, Yehuda D.