结直肠癌幸存者健康相关生活质量的社会经济差异。
Socioeconomic disparities in health-related quality of life among colorectal cancer survivors.
机构信息
University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA.
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA.
出版信息
J Cancer Surviv. 2019 Jun;13(3):459-467. doi: 10.1007/s11764-019-00767-9. Epub 2019 May 20.
PURPOSE
Improvements in colorectal cancer (CRC) prevention, early detection, and treatment have resulted in substantial gains in survival. However, the health-related quality of life (HRQoL) of CRC survivors often depends on access to supportive care, which differs by survivors' socioeconomic characteristics. The purpose of this study was to investigate the relationship between socioeconomic characteristics and HRQoL in a diverse group of CRC survivors.
METHODS
We conducted a population-based, cross-sectional study to examine the association between socioeconomic factors (household income, health literacy, and insurance status) and HRQoL domains of pain interference, fatigue, physical function, sleep disturbance, anxiety, and depression. PROMIS® Short Forms v.2.0 were used to assess domains of HRQoL. Linear regression modeling was used to estimate the coefficient representing the average HRQoL domain score and its 95% confidence interval (CI).
RESULTS
Three hundred one CRC survivors participated in the survey. Low-income (≤ $30,000) CRC survivors had, on average, a 4.70-point (95% CI 1.10-8.28) higher pain interference score, a 7.02-point (95% CI 3.27-10.77) higher fatigue score, a 5.13-point (95% CI - 8.56 to - 1.71) lower physical function score, and a 4.44-point (95% 1.40-7.49) higher depression score than CRC survivors with an income ≥ $70,000. Survivors with Medicaid insurance reported significantly greater pain interference and worse physical function than privately insured survivors. Survivors with low health literacy reported significantly greater pain interference compared with survivors with high health literacy.
CONCLUSIONS
Substantial socioeconomic disparities in HRQoL were observed in this diverse population of CRC survivors.
IMPLICATIONS FOR CANCER SURVIVORS
Designing supportive care interventions to improve HRQoL among low-income and Medicaid-insured CRC survivors is critical for eliminating disparities in CRC outcomes.
目的
结直肠癌（CRC）预防、早期检测和治疗的改善使生存率得到了显著提高。然而，CRC 幸存者的健康相关生活质量（HRQoL）往往取决于获得支持性护理的机会，而这又因幸存者的社会经济特征而异。本研究的目的是调查一组不同 CRC 幸存者的社会经济特征与 HRQoL 之间的关系。
方法
我们进行了一项基于人群的横断面研究，以检查社会经济因素（家庭收入、健康素养和保险状况）与疼痛干扰、疲劳、身体机能、睡眠障碍、焦虑和抑郁等 HRQoL 领域之间的关联。使用 PROMIS®短表单 v.2.0 评估 HRQoL 领域。线性回归建模用于估计代表平均 HRQoL 领域得分及其 95%置信区间（CI）的系数。
结果
301 名 CRC 幸存者参与了调查。低收入（≤30000 美元）CRC 幸存者的疼痛干扰评分平均高出 4.70 分（95%CI 1.10-8.28），疲劳评分高出 7.02 分（95%CI 3.27-10.77），身体机能评分低 5.13 分（95%CI-8.56 至-1.71），抑郁评分高 4.44 分（95%CI 1.40-7.49），而收入≥70000 美元的 CRC 幸存者。有医疗补助保险的幸存者报告的疼痛干扰明显更大，身体机能更差，而私人保险的幸存者则相反。健康素养低的幸存者报告的疼痛干扰明显大于健康素养高的幸存者。
结论
在这个多样化的 CRC 幸存者群体中，观察到 HRQoL 存在显著的社会经济差异。
对癌症幸存者的意义
设计支持性护理干预措施以提高低收入和有医疗补助保险的 CRC 幸存者的 HRQoL，对于消除 CRC 结果的差异至关重要。
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