Patel Krishan S, Alhatem Albert, Gadde Uttara, Ahlawat Sushil, Lambert Clark, Schwartz Robert A, Dalla Piazza Michelle
Rutgers New Jersey Medical School, Newark, NJ, United States.
Rutgers New Jersey Medical School, Newark, NJ, United States; Department of Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States.
Cancer Epidemiol. 2020 Aug;67:101723. doi: 10.1016/j.canep.2020.101723. Epub 2020 May 11.
Anal squamous cell carcinoma (ASCC) is relatively rare, but its incidence and mortality have been steadily climbing in marginalized populations. We explored the impact of insurance status, education, and income on survival and receipt of chemoradiation therapy.
We included patients with ASCC from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Socioeconomic variables included insurance status, level of education, income, and unemployment rate. Cox proportional hazards and multivariate logistic regression were used to determine predictors of survival and receipt of chemoradiation.
We included a total of 10,868 cases of ASCC. The median age was 55, 10.4 % were black, and 65.4 % were female. Overall, 74.1 % of patients received combination chemoradiation. In multivariate analysis, poorer survival was found for Medicaid (HR 1.52, 95 % CI 1.34-1.74) and uninsured (HR 1.68, 95 % CI 1.35-2.10) patients, and for communities with the lowest rates of high school education (HR 1.17, 95 % CI 1.02-1.38), lowest income (HR 1.29, 95 % CI 1.08-1.54), and highest unemployment (HR 1.21, 95 % CI 1.03-1.40). Patients were less likely to receive combination treatment if they were black (OR 0.76, 95 % CI 0.55-0.92), had Medicaid insurance (OR 0.54, 95 % CI 0.33-0.88) or lower education (OR 0.59, 95 % CI 0.46-0.76).
Insurance status, level of education, income, and employment impact survival and receipt of treatment in patients with ASCC. Identifying high risk patients and developing targeted interventions to improve access to treatment is integral to reducing these disparities and improving cancer survival.
肛管鳞状细胞癌（ASCC）相对罕见，但在边缘化人群中的发病率和死亡率一直在稳步攀升。我们探讨了保险状况、教育程度和收入对生存及接受放化疗的影响。
我们纳入了2004年至2016年监测、流行病学和最终结果计划数据库中的ASCC患者。社会经济变量包括保险状况、教育水平、收入和失业率。采用Cox比例风险模型和多变量逻辑回归来确定生存及接受放化疗的预测因素。
我们共纳入10868例ASCC病例。中位年龄为55岁，10.4%为黑人，65.4%为女性。总体而言，74.1%的患者接受了联合放化疗。在多变量分析中，医疗补助患者（风险比[HR] 1.52，95%置信区间[CI] 1.34 - 1.74）和未参保患者（HR 1.68，95% CI 1.35 - 2.10），以及高中教育率最低（HR 1.17，95% CI 1.02 - 1.38）、收入最低（HR 1.29，95% CI 1.08 - 1.54）和失业率最高（HR 1.21，95% CI 1.03 - 1.40）的社区患者，生存情况较差。如果患者为黑人（比值比[OR] 0.76，95% CI 0.55 - 0.92）、拥有医疗补助保险（OR 0.54，95% CI 0.33 - 0.88）或教育程度较低（OR 0.59，95% CI 0.46 - 0.76），则接受联合治疗的可能性较小。
保险状况、教育水平、收入和就业情况会影响ASCC患者的生存及治疗接受情况。识别高危患者并制定针对性干预措施以改善治疗可及性，对于减少这些差异和提高癌症生存率至关重要。
