Department of Population and Data Sciences, Internal Medicine, and Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
J Natl Cancer Inst. 2021 Aug 2;113(8):1074-1083. doi: 10.1093/jnci/djab006.
Adolescents and young adults (AYA, aged 15-39 years) diagnosed with cancer comprise a growing, yet understudied, population. Few studies have examined disparities in cancer survival in underserved and diverse populations of AYA.
Using population-based data from the Texas Cancer Registry, we estimated 5-year relative survival of common AYA cancers and examined disparities in survival by race and ethnicity, neighborhood poverty, urban or rural residence, and insurance type. We also used multivariable Cox proportional hazards regression models to examine associations of race or ethnicity, neighborhood poverty, urban or rural residence, and insurance type with all-cause mortality.
We identified 55 316 women and 32 740 men diagnosed with invasive cancer at age 15-39 years between January 1, 1995, and December 31, 2016. There were disparities in relative survival by race and ethnicity, poverty, and insurance for many cancer types. Racial and ethnic disparities in survival for men with non-Hodgkin lymphoma (74.5% [95% confidence interval (CI) = 72.1% to 76.7%] White vs 57.0% [95% CI = 51.9% to 61.8%] Black) and acute lymphocytic leukemia (66.5% [95% CI = 61.4% to 71.0%] White vs 44.4% [95% CI = 39.9% to 48.8%] Hispanic) were striking, and disparities remained even for cancers with excellent prognosis, such as testicular cancer (96.6% [95% CI = 95.9% to 97.2%] White vs 88.7% [95% CI = 82.4% to 92.8%] Black). In adjusted analysis, being Black or Hispanic, living in high-poverty neighborhoods, and having Medicaid, other government insurance, or no insurance at diagnosis were associated with all-cause mortality in both women and men (all 2-sided P < .01).
Our study adds urgency to well-documented disparities in cancer survival in older adults by demonstrating persistent differences in relative survival and all-cause mortality in AYAs. Findings point to several areas of future research to address disparities in this unique population of cancer patients.
青少年和年轻成年人（AYA，年龄在 15-39 岁之间）患有癌症的比例在不断增加，但对这一人群的研究还很有限。很少有研究调查服务不足和多样化的 AYA 人群中癌症生存的差异。
利用来自德克萨斯癌症登记处的基于人群的数据，我们估计了常见 AYA 癌症的 5 年相对生存率，并检查了种族和族裔、社区贫困、城市或农村居住和保险类型等因素对生存率的影响。我们还使用多变量 Cox 比例风险回归模型来检查种族或族裔、社区贫困、城市或农村居住和保险类型与全因死亡率之间的关联。
我们在 1995 年 1 月 1 日至 2016 年 12 月 31 日期间，确定了 55316 名女性和 32740 名男性在 15-39 岁时被诊断为侵袭性癌症。对于许多癌症类型，种族和族裔、贫困和保险都会导致生存率的差异。男性中非霍奇金淋巴瘤（74.5%[95%置信区间（CI）=72.1%至 76.7%]白人比 57.0%[95%CI=51.9%至 61.8%]黑人）和急性淋巴细胞白血病（66.5%[95%CI=61.4%至 71.0%]白人比 44.4%[95%CI=39.9%至 48.8%]西班牙裔）的生存差异显著，即使对于预后良好的癌症，如睾丸癌（96.6%[95%CI=95.9%至 97.2%]白人比 88.7%[95%CI=82.4%至 92.8%]黑人）也存在差异。在调整分析中，黑人和西班牙裔、居住在高贫困社区以及在诊断时拥有医疗补助、其他政府保险或没有保险，与女性和男性的全因死亡率相关（均双侧 P<0.01）。
我们的研究通过证明 AYA 人群在相对生存率和全因死亡率方面持续存在差异，为老年人中已被充分记录的癌症生存差异增添了紧迫感。研究结果指出了未来研究的几个领域，以解决这一独特癌症患者群体中的差异问题。
