Department of Surgery, The Ohio State University Wexner Medical Center, James Comprehensive Cancer Center, Columbus, Ohio, USA.
National Clinician Scholars Program at the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
J Surg Oncol. 2021 Oct;124(5):886-893. doi: 10.1002/jso.26588. Epub 2021 Jul 1.
While the impact of demographic factors on postoperative outcomes has been examined, little is known about the intersection between social vulnerability and residential diversity on postoperative outcomes following cancer surgery.
Individuals who underwent a lung or colon resection for cancer were identified in the 2016-2017 Medicare database. Data were merged with the Centers for Disease Control and Prevention social vulnerability index and a residential diversity index was calculated. Logistic regression models were utilized to estimate the probability of postoperative outcomes.
Among 55 742 Medicare beneficiaries who underwent lung (39.4%) or colon (60.6%) resection, most were male (46.6%), White (90.2%) and had a mean age of 75.3 years. After adjustment for competing risk factors, both social vulnerability and residential diversity were associated with mortality and other postoperative outcomes. In assessing the intersection of social vulnerability and residential diversity, synergistic effects were noted as patients from counties with low social vulnerability and high residential diversity had the lowest probability of 30-day mortality (3.2%, 95% confidence interval [CI]: 3.0-3.5) while patients from counties with high social vulnerability and low diversity had a higher probability of 30-day postoperative death (5.2%, 95% CI: 4.6-5.8; odds ratio: 1.02, 95% CI: 1.01-1.03).
Social vulnerability and residential diversity were independently associated with postoperative outcomes. The intersection of these two social health determinants demonstrated a synergistic effect on the risk of adverse outcomes following lung and colon cancer surgery.
尽管人口因素对术后结果的影响已得到研究，但对于癌症手术后社会脆弱性和居住多样性之间的交叉关系对术后结果的影响知之甚少。
在 2016-2017 年 Medicare 数据库中确定了接受肺癌或结肠癌切除术的患者。将数据与疾病控制与预防中心的社会脆弱性指数合并，并计算了居住多样性指数。利用逻辑回归模型来估计术后结果的概率。
在 55742 名接受肺切除术（39.4%）或结肠切除术（60.6%）的 Medicare 受益人中，大多数为男性（46.6%），白人（90.2%），平均年龄为 75.3 岁。在调整了竞争风险因素后，社会脆弱性和居住多样性均与死亡率和其他术后结果相关。在评估社会脆弱性和居住多样性的交叉点时，注意到了协同作用，因为来自社会脆弱性低且居住多样性高的县的患者，30 天死亡率的概率最低（3.2%，95%置信区间[CI]：3.0-3.5），而来自社会脆弱性高且居住多样性低的县的患者，30 天术后死亡的概率更高（5.2%，95%CI：4.6-5.8；优势比：1.02，95%CI：1.01-1.03）。
社会脆弱性和居住多样性与术后结果独立相关。这两个社会健康决定因素的交叉点对肺癌和结肠癌手术后不良结果的风险表现出协同作用。
