The intersectionality of gender and poverty on symptom suffering among adolescents with cancer.
The intersectionality of gender and poverty on symptom suffering among adolescents with cancer.
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DOI：
10.1002/pbc.29144
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发表时间：
2021-08
影响因子：
3.2
通讯作者：
Wang J
中科院分区：
文献类型：
--
作者：
Lyon ME;Cheng YI;Needle J;Friebert S;Baker JN;Jiang J;Wang J
确定性别和贫困的交叉性是否与青少年癌症患者的健康差异有关。我们假设未观察到的潜在类别的患者存在与癌症相关的症状;和类分类不同的性别贫困组合。横断面数据收集在青少年癌症和家庭（N = 126 dyads）在四个三级儿科医院。青少年年龄为14-21岁，讲英语，癌症诊断，没有发育迟缓，精神病，杀人，自杀或严重抑郁。使用潜在类别分析和多项logit模型进行分析。患者报告结局测量信息系统（PROMIS）儿科症状测量，简表，评估焦虑、抑郁症状、疼痛干扰和疲劳。家庭报告的家庭收入使用2016年联邦贫困水平（FPL）指南。使用PROMIS症状模式确定了三个不同的患者组：高痛苦-25%;高身体/低心理痛苦-14%;和低痛苦-62%。生活在收入等于或低于2016年FPL的家庭中的女性青少年被归类为高痛苦类别的几率是30倍（与高身体/低心理痛苦类别的人相比，经历焦虑、抑郁症状、疼痛干扰和疲劳的可能性更高）（女性和贫困：AOR = 30.27，95% CI 1.23，735.10），这具有统计学显著性（β = 3.41，95% CI 0.21，6.60; p = 0.04），但与低痛苦组相比无统计学显著性。与那些身体痛苦高但心理痛苦低的人相比，家庭贫困的癌症青少年女性经历高症状痛苦的几率要大得多。根据需要进行更全面的筛查和干预，可能会减少差距。
To determine if the intersectionality of gender and poverty is associated with health disparities among adolescents with cancer. We hypothesized unobserved latent classes of patients exist with respect to cancer-related symptoms; and class classification varies by gender–poverty combinations. Cross-sectional data were collected among adolescents with cancer and families (N = 126 dyads) at four tertiary pediatric hospitals. Adolescents were aged 14–21 years, English speaking, cancer diagnosis, not developmentally delayed, psychotic, homicidal, suicidal, or severely depressed. Latent class analysis and multinomial logit models were used for analysis. Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric symptom measures, Short forms, evaluated anxiety, depressive symptoms, pain interference, and fatigue. Family-reported household income used 2016 Federal Poverty Level (FPL) guidelines. Three distinct groups of patients were identified using PROMIS symptom patterns: High Distress-25%; High Physical/Low Psychological Distress-14%; and Low Distress-62%. Female adolescents living in households with incomes at or below the 2016 FPL had 30 times the odds of being classified in the High Distress class (higher probabilities of experiencing anxiety, depressive symptoms, pain interference, and fatigue) compared to those in the High Physical/Low Psychological Distress class (female and poverty: AOR = 30.27, 95% CI 1.23, 735.10), and this was statistically significant (β = 3.41, 95% CI 0.21, 6.60; p = .04) but not compared to those in Low Distress. Adolescent females with cancer with households in poverty had significantly greater odds of experiencing high symptom distress, compared to those with high physical but low psychological distress. More comprehensive screening and intervention, as needed, may decrease disparities.
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