Socioeconomic Disparities in Survival After Hodgkin Lym*

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DESCRIPTION (provided by applicant): Hodgkin Lymphoma (HL) is 1 of the most common cancers of young adults and, because of successful treatment strategies, is generally considered curable for this age group at all stages of disease. Treatment, however, is associated with significant sequelae such that survivors experience some of the highest rates of second primary cancers, HL recurrences, and radiation-induced cardiac disease, with associated mortality. This outcome is particularly tragic considering the young age of most HL patients and the potential years of life lost following HL. Our preliminary data, and limited other prior research, have revealed disparities in HL survival by socioeconomic status (SES), particularly in young adults. Therefore, utilizing California Cancer Registry (CCR) patient data enhanced by geographic linkage with US Census SES data and with hospital and physician characteristics, we will undertake an efficient, cost-effective, population-based secondary data analysis to examine the effects of neighborhood SES on long-term survival following HL. Specifically, we will evaluate both overall survival (which takes into account death associated with HL, treatment sequelae and non-cancer events) and HL-specific survival, after considering patient characteristics, including race/ethnicity and histologic subtype, and markers of health care. We also will compare the survival experience of HL patients to that of comparable non-cancer patients (relative survival), adjusted for neighborhood SES and within specific racial/ethnic groups. These analyses will include demographic, clinical and tumor data for all (n = -3,800) HL cases newly diagnosed throughout California during 1988-1992 and reported to the population-based CCR; a neighborhood SES composite index derived from the 1990 US Census based on the patient's residence at diagnosis; hospital characteristics from the American Hospital Association; and 10-15 years of vital-status follow-up information. For these survival analyses, we will use multivariate adjusted Cox proportional hazards modeling and SEER*Stat software and stratify analyses by age and race/ethnicity. The study's overall objective is to document SES disparities in long-term survival following HL in an unbiased, population-based, and racially and ethnically diverse case series that will yield generalizable and thus interpretable results. If this study finds survival disparities, it will provide the foundation and impetus for more targeted studies to investigate the likely complex explanatory mechanisms, such as variation in access to and quality of care, incidence of side effects and management of long-term health, and health behaviors, stated goals of the NCI. By evaluating SES disparities in long-term survival, this study is an important first step in overcoming such disparities by helping inform decision-makers about specific populations in whom the length and quality of life can be improved following HL diagnoses.