癌症幸存者与失业：一项荟萃分析和元回归分析

Cancer survivors and unemployment: a meta-analysis and meta-regression.

作者信息

de Boer Angela G E M, Taskila Taina, Ojajärvi Anneli, van Dijk Frank J H, Verbeek Jos H A M

机构信息

Coronel Institute of Occupational Health, Academic Medical Center, PO Box 22700, 1100 DE Amsterdam, The Netherlands.

出版信息

JAMA. 2009 Feb 18;301(7):753-62. doi: 10.1001/jama.2009.187.

DOI:10.1001/jama.2009.187

PMID:19224752

Abstract

CONTEXT

Nearly half of adult cancer survivors are younger than 65 years, but the association of cancer survivorship with employment status is unknown.

OBJECTIVE

To assess the association of cancer survivorship with unemployment compared with healthy controls.

DATA SOURCES

A systematic search of studies published between 1966 and June 2008 was conducted using MEDLINE, CINAHL, EMBASE, PsycINFO, and OSH-ROM databases.

STUDY SELECTION

Eligible studies included adult cancer survivors and a control group, and employment as an outcome.

DATA EXTRACTION

Pooled relative risks were calculated over all studies and according to cancer type. A Bayesian meta-regression analysis was performed to assess associations of unemployment with cancer type, country of origin, average age at diagnosis, and background unemployment rate.

RESULTS

Twenty-six articles describing 36 studies met the inclusion criteria. The analyses included 20,366 cancer survivors and 157,603 healthy control participants. Studies included 16 from the United States, 15 from Europe, and 5 from other countries. Overall, cancer survivors were more likely to be unemployed than healthy control participants (33.8% vs 15.2%; pooled relative risk [RR], 1.37; 95% confidence interval [CI], 1.21-1.55). Unemployment was higher in breast cancer survivors compared with control participants (35.6% vs 31.7%; pooled RR, 1.28; 95% CI, 1.11-1.49), as well as in survivors of gastrointestinal cancers (48.8% vs 33.4%; pooled RR, 1.44; 95% CI, 1.02-2.05), and cancers of the female reproductive organs (49.1% vs 38.3%; pooled RR, 1.28; 95% CI, 1.17-1.40). Unemployment rates were not higher for survivors of blood cancers compared with controls (30.6% vs 23.7%; pooled RR, 1.41; 95% CI, 0.95-2.09), prostate cancers (39.4% vs 27.1%; pooled RR, 1.11; 95% CI, 1.00-1.25), or testicular cancer (18.5% vs 18.1%; pooled RR, 0.94; 95% CI, 0.74-1.20). For survivors in the United States, the unemployment risk was 1.5 times higher compared with survivors in Europe (meta-RR, 1.48; 95% credibility interval, 1.15-1.95). After adjustment for diagnosis, age, and background unemployment rate, this risk disappeared (meta-RR, 1.24; 95% CI, 0.85-1.83).

CONCLUSION

Cancer survivorship is associated with unemployment.

摘要

背景

近一半的成年癌症幸存者年龄小于65岁，但癌症幸存者与就业状况之间的关联尚不清楚。

目的

评估与健康对照相比，癌症幸存者与失业之间的关联。

数据来源

使用MEDLINE、CINAHL、EMBASE、PsycINFO和OSH-ROM数据库对1966年至2008年6月发表的研究进行系统检索。

研究选择

符合条件的研究包括成年癌症幸存者和一个对照组，并将就业作为一项结果。

数据提取

计算所有研究以及按癌症类型分组的合并相对风险。进行贝叶斯元回归分析以评估失业与癌症类型、原产国、诊断时的平均年龄和背景失业率之间的关联。

结果

26篇描述36项研究的文章符合纳入标准。分析纳入了20366名癌症幸存者和157603名健康对照参与者。研究包括来自美国的16项、来自欧洲的15项和来自其他国家的5项。总体而言，癌症幸存者比健康对照参与者更有可能失业（33.8%对15.2%；合并相对风险[RR]，1.37；95%置信区间[CI]，1.21 - 1.55）。与对照参与者相比，乳腺癌幸存者的失业率更高（分别为35.6%和31.7%；合并RR，1.28；95% CI，1.11 - 1.49），胃肠道癌症幸存者也是如此（分别为48.8%和33.4%；合并RR，1.44；95% CI，1.02 - 2.05），以及女性生殖器官癌症幸存者（分别为49.1%和38.3%；合并RR，1.28；95% CI，1.17 - 1.40）。与对照组相比，血癌幸存者（分别为30.6%和23.7%；合并RR，1.41；95% CI，0.95 - 2.09）、前列腺癌幸存者（分别为39.4%和27.1%；合并RR，1.11；95% CI，1.00 - 1.25）或睾丸癌幸存者（分别为18.5%和18.1%；合并RR，0.94；95% CI，0.74 - 1.20）的失业率并不更高。对于美国的幸存者，与欧洲的幸存者相比，失业风险高出1.5倍（元RR，1.48；95%可信区间，1.15 - 1.95）。在对诊断、年龄和背景失业率进行调整后，这种风险消失了（元RR，1.24；95% CI，0.85 - 1.83）。