DeRouen Mindy C, Parsons Helen M, Kent Erin E, Pollock Brad H, Keegan Theresa H M
Cancer Prevention Institute of California, 2201 Walnut Ave, Suite 300, Fremont, CA, 94538, USA.
Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
Cancer Causes Control. 2017 Aug;28(8):841-851. doi: 10.1007/s10552-017-0914-y. Epub 2017 Jun 28.
To investigate associations of sociodemographic factors-race/ethnicity, neighborhood socioeconomic status (SES), and health insurance-with survival for adolescents and young adults (AYAs) with invasive cancer.
Data on 80,855 AYAs with invasive cancer diagnosed in California 2001-2011 were obtained from the California Cancer Registry. We used multivariable Cox proportional hazards regression to estimate overall survival.
Associations of public or no insurance with greater risk of death were observed for 11 of 12 AYA cancers examined. Compared to Whites, Blacks experienced greater risk of death, regardless of age or insurance, while greater risk of death among Hispanics and Asians was more apparent for younger AYAs and for those with private/military insurance. More pronounced neighborhood SES disparities in survival were observed among AYAs with private/military insurance, especially among younger AYAs.
Lacking or having public insurance was consistently associated with shorter survival, while disparities according to race/ethnicity and neighborhood SES were greater among AYAs with private/military insurance. While health insurance coverage associates with survival, remaining racial/ethnic and socioeconomic disparities among AYAs with cancer suggest additional social factors also need consideration in intervention and policy development.
探讨社会人口学因素（种族/族裔、邻里社会经济地位[SES]和医疗保险）与侵袭性癌症青少年及青年（AYA）患者生存率之间的关联。
从加利福尼亚癌症登记处获取了2001 - 2011年在加利福尼亚诊断出的80,855例侵袭性癌症AYA患者的数据。我们使用多变量Cox比例风险回归来估计总生存率。
在所检查的12种AYA癌症中，有11种观察到公共保险或无保险与更高的死亡风险相关。与白人相比，黑人无论年龄或保险状况如何，死亡风险都更高，而西班牙裔和亚裔中，年龄较小的AYA以及有私人/军人保险的AYA死亡风险更高。在有私人/军人保险的AYA中，尤其是年龄较小的AYA中，观察到邻里SES在生存率方面的差异更为明显。
缺乏保险或拥有公共保险始终与较短的生存期相关，而在有私人/军人保险的AYA中，根据种族/族裔和邻里SES的差异更大。虽然医疗保险覆盖与生存率相关，但患有癌症的AYA中仍然存在的种族/族裔和社会经济差异表明，在干预和政策制定中还需要考虑其他社会因素。
