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所有阶段都是可治愈的。然而，治疗与显著的后遗症相关，例如幸存者经历了一些最高的第二原发性癌症、HL复发和辐射诱导的心脏病的发生率，以及相关的死亡率。考虑到大多数HL患者的年龄较小以及HL后潜在的寿命损失，该结局尤其悲惨。我们的初步数据，以及有限的其他先前研究，揭示了HL生存的社会经济地位（SES）的差异，特别是在年轻人。因此，利用加州癌症登记处（CCR）的患者数据，通过与美国人口普查SES数据的地理联系以及医院和医生的特征进行增强，我们将进行一项有效的、具有成本效益的、基于人群的二级数据分析，以检查社区SES对HL后长期生存的影响。具体而言，我们将在考虑患者特征（包括人种/种族和组织学亚型）以及医疗保健标志物后，评价总生存期（考虑与HL相关的死亡、治疗后遗症和非癌症事件）和HL特异性生存期。我们还将比较HL患者与可比的非癌症患者的生存经验（相对生存期），调整了社区SES和特定种族/民族组。这些分析将包括所有受试者的人口统计学、临床和肿瘤数据。（n =-3，800）1988-1992年期间在整个加州新诊断并报告给基于人群的CCR的HL病例;基于患者诊断时居住地的1990年美国人口普查得出的社区SES复合指数;来自美国医院协会的医院特征;以及10-15年的生命状态随访信息。对于这些生存分析，我们将使用多变量调整的考克斯比例风险模型和SEER*Stat软件，并按年龄和人种/种族进行分层分析。该研究的总体目标是在一个无偏倚、基于人群、种族和人种多样的病例系列中记录HL后长期生存的SES差异，从而产生可推广的结果。如果这项研究发现了生存差异，它将为更有针对性的研究提供基础和动力，以调查可能的复杂解释机制，例如获得和护理质量的变化，副作用的发生率和长期健康管理，以及健康行为，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的第一步，帮助决策者了解HL诊断后可以改善生活长度和质量的特定人群。

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.