Socioeconomic Disparities in Survival After Hodgkin Lym*

霍奇金淋巴瘤后生存的社会经济差异*

• 批准号: 7003259
• 负责人: Theresa H M Keegan
• 金额: $ 7.06万
• 依托单位: CANCER PREVENTION INSTIT OF CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7003259
• 关键词: Hodgkin' s disease; behavioral /social science research tag; clinical research; geographic difference; health disparity; health services research tag; human data; long term survivor; low socioeconomic status; medically underserved population; neoplasm /cancer epidemiology; socioeconomics

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.

描述（由申请人提供）：霍奇金淋巴瘤（HL）是最常见的年轻人癌症之一，由于成功的治疗策略，通常认为在疾病的所有阶段，该年龄段都可以治愈。然而，治疗与重大后遗症有关，使得幸存者经历了第二次原发性癌症，HL复发和辐射诱导的心脏病的最高率，并及其相关死亡率。考虑到大多数HL患者的年龄以及HL后生命的潜在年龄，这种结果尤其悲惨。我们的初步数据以及其他先前的研究有限，已经揭示了社会经济地位（SES）的HL生存差异，尤其是在年轻人中。因此，利用加利福尼亚癌症注册中心（CCR）患者数据通过与美国人口普查数据以及医院和医师特征相关的地理联系增强，我们将进行有效的，具有成本效益的，基于人群的二级数据分析，以研究邻里SES对HL后长期存活的影响。具体而言，我们将在考虑患者特征（包括种族/民族和组织学亚型）以及医疗保健的标志后，将评估总体生存期（考虑到与HL，治疗后遗症和非癌症事件相关的死亡）和HL特异性生存。我们还将比较HL患者的生存经验与可比的非癌症患者（相对生存），对邻里SES和特定种族/族裔的调整。这些分析将包括所有（n = -3,800）HL病例的人口统计，临床和肿瘤数据，在1988 - 1992年期间在整个加利福尼亚州新诊断，并向基于人群的CCR报告；根据患者在诊断时的住所，属于1990年美国人口普查的社区SES综合指数；美国医院协会的医院特征；以及10 - 15年的生命状态后续信息。对于这些生存分析，我们将使用多元调整后的COX比例危害建模和SEER*Stat软件，并按年龄和种族/种族进行分层分析。该研究的总体目标是在HL之后记录长期生存的SES差异，这是一个公正的，基于人群的，种族和种族多样性的案例系列，该案例将产生可概括的结果，从而产生可解释的结果。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，以研究可能复杂的解释机制，例如NCI的目标，例如获得和护理质量的变化和护理质量，副作用和长期健康的管理以及健康行为。通过评估长期生存中的SES差异，这项研究是克服此类差异的重要第一步，它可以帮助决策者了解特定人群，在HL诊断后可以改善生活的长度和生活质量。

项目成果

Disparities in survival after Hodgkin lymphoma: a population-based study.

• DOI: 10.1007/s10552-009-9382-3
• 发表时间: 2009-12
• 期刊: CANCER CAUSES & CONTROL
• 影响因子: 2.3
• 作者: Keegan, Theresa H. M.;Clarke, Christina A.;Chang, Ellen T.;Shema, Sarah J.;Glaser, Sally L.
• 通讯作者: Glaser, Sally L.