Socioeconomic Disparities in Survival After Hodgkin Lym*

描述（由申请人提供）：霍奇金淋巴瘤 (HL) 是年轻人最常见的癌症之一，由于成功的治疗策略，通常认为该年龄组在疾病的各个阶段都可以治愈。然而，治疗会带来严重的后遗症，例如幸存者罹患第二原发癌、HL 复发和放射诱发的心脏病的几率最高，并伴有相关的死亡率。考虑到大多数 HL 患者年龄较小以及 HL 后可能损失的寿命，这一结果尤其悲惨。我们的初步数据以及有限的其他先前研究揭示了不同社会经济地位 (SES) 的 HL 生存率差异，特别是在年轻人中。因此，利用通过与美国人口普查 SES 数据以及医院和医生特征的地理联系增强的加州癌症登记处 (CCR) 患者数据，我们将进行高效、具有成本效益、基于人群的二次数据分析，以检查社区 SES 对 HL 后长期生存的影响。具体来说，我们将在考虑患者特征（包括种族/民族和组织学亚型以及医疗保健标志物）后评估总体生存率（考虑与 HL 相关的死亡、治疗后遗症和非癌症事件）和 HL 特异性生存率。我们还将比较 HL 患者的生存经历与可比较的非癌症患者的生存经历（相对生存），并根据社区社会经济地位和特定种族/民族群体进行调整。这些分析将包括 1988 年至 1992 年期间加州各地新诊断的所有 (n = -3,800) HL 病例的人口统计、临床和肿瘤数据，并向基于人口的 CCR 报告；社区 SES 综合指数源自 1990 年美国人口普查，基于患者诊断时的居住地；美国医院协会的医院特色；以及 10-15 年的生命状态跟踪信息。对于这些生存分析，我们将使用多变量调整 Cox 比例风险模型和 SEER*Stat 软件，并按年龄和种族/民族进行分层分析。该研究的总体目标是通过公正的、基于人口的、种族和族裔多样化的病例系列记录 HL 后长期生存的 SES 差异，从而产生可推广且可解释的结果。如果这项研究发现生存差异，它将为更有针对性的研究提供基础和动力，以调查可能复杂的解释机制，例如护理获取和质量的变化、副作用的发生率和长期健康管理以及健康行为，这是 NCI 的既定目标。通过评估 SES 在长期生存方面的差异，这项研究是克服这种差异的重要第一步，帮助决策者了解在 HL 诊断后可以改善哪些特定人群的生活长度和生活质量。

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.