Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul, South Korea.
Department of Radiation Oncology, SMG-SNU Boramae Medical Center, Seoul, South Korea.
Cancer Med. 2019 Jul;8(7):3604-3613. doi: 10.1002/cam4.2231. Epub 2019 May 8.
We hypothesized that lower socioeconomic status (SES) was associated with higher all-cause mortality in patients newly diagnosed with cancer, particularly in the elderly population.
We collected study patients from the stratified random sample of Korean National Health Insurance Elderly Cohort (2002-2015). The Cox's proportional hazards model was used to investigate the risk factors for mortality. Income level and composite deprivation index (CDI) 2010 were used to define the SES: low, intermediate, and high SES groups. The comorbidities were measured using Charlson Comorbidity Index score. After a wash-out period (2002), the final study population was 108 626 (2003-2015).
In multivariate analysis, low SES was associated with poor overall survival (OS) (HR = 1.08, 95% CI: 1.05-1.12, P < 0.001) and cancer-specific survival (CSS) (HR = 1.11, 95% CI: 1.06-1.16, P < 0.001) particularly for patients aged 70-79 years. High SES was favorable prognostic factor of OS in patients aged 60-69 years (HR = 0.85, 95% CI: 0.81-0.89, P < 0.001), 70-79 years (HR = 0.90, 95% CI: 0.87-0.93, P < 0.001), and ≥80 years (HR = 0.91, 95% CI: 0.87-0.96, P < 0.001). However, SES was not associated with CSS in advanced age patients (≥80 years). Patients with low SES manifesting colorectal, urinary, liver, gastric, melanoma, and esophageal cancers demonstrated worse OS, compared to patients with intermediate SES. Also, low SES patients with urinary, liver, or colorectal cancers or melanoma demonstrated worse CSS compared to those with intermediate SES.
Low SES at the time of cancer diagnosis is associated with increased risk of OS and CSS in elderly patients. Depending on cancer sites, different patterns of OS and CSS were observed according to SES. Further elucidation of the causes underlying these phenomena is needed along with appropriate support for elderly cancer patients with low SES.
我们假设较低的社会经济地位（SES）与新诊断癌症患者的全因死亡率相关，尤其是在老年人群中。
我们从韩国国民健康保险老年队列的分层随机样本中收集研究患者（2002-2015 年）。使用 Cox 比例风险模型来研究死亡率的危险因素。收入水平和综合贫困指数（CDI）2010 用于定义 SES：低 SES、中 SES 和高 SES 组。使用 Charlson 合并症指数评分来测量合并症。在洗脱期（2002 年）后，最终研究人群为 108626 人（2003-2015 年）。
在多变量分析中，低 SES 与较差的总生存（OS）（HR=1.08，95%CI：1.05-1.12，P<0.001）和癌症特异性生存（CSS）（HR=1.11，95%CI：1.06-1.16，P<0.001）相关，特别是对于 70-79 岁的患者。高 SES 是 60-69 岁（HR=0.85，95%CI：0.81-0.89，P<0.001）、70-79 岁（HR=0.90，95%CI：0.87-0.93，P<0.001）和≥80 岁（HR=0.91，95%CI：0.87-0.96，P<0.001）患者 OS 的有利预后因素。然而，SES 与高龄患者（≥80 岁）的 CSS 无关。与中 SES 患者相比，表现为结直肠癌、泌尿系统、肝脏、胃癌、黑色素瘤和食管癌的低 SES 患者 OS 更差。此外，与中 SES 患者相比，患有泌尿系统、肝脏或结直肠癌或黑色素瘤的低 SES 患者 CSS 更差。
癌症诊断时的低 SES 与老年患者 OS 和 CSS 风险增加相关。根据癌症部位，SES 会导致不同的 OS 和 CSS 模式。需要进一步阐明这些现象的原因，并为 SES 较低的老年癌症患者提供适当的支持。
