Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Institute of Education, Nanjing University, Nanjing, China.
Front Public Health. 2022 Jun 9;10:868416. doi: 10.3389/fpubh.2022.868416. eCollection 2022.
It remains largely unclear how education level, an important socioeconomic factor, affects prognoses for patients with gastric adenocarcinoma (GAC). We aimed to demonstrate the associations between education level and clinical outcomes in patients with GAC.
We included a total of 30,409 patients diagnosed with GAC from the Surveillance, Epidemiology, and End Results 18 registry database. Education level, household income, unemployment rate, poverty rate, insurance status, and marital status were selected as sociodemographic variables for the comprehensive analysis. Cox and logistic regression models, Kaplan-Meier curves, and subgroup analyses were the primary statistical methods employed.
A low level of education was correlated with less income, higher unemployment rates, and higher poverty rates (all < 0.001). The multivariate Cox analysis indicated that a high education level was significantly associated with superior overall survival rates and cancer-specific survival rates in patients with GAC (both < 0.001). We also corroborated favorable survival outcomes by high education level within almost every clinical and demographic subgroup. Furthermore, chemotherapy combined with surgery could markedly prolong the survival for all patients, including patients of stage IV cancer (both < 0.001). By using multivariable logistic models, patients in counties with high education levels had a higher probability of chemotherapy receipt ( < 0.001). Contrarily, those in the counties with low levels of education were less likely to receive chemotherapy or undergo surgery ( < 0.001).
Education level was identified and confirmed as an independent predictor of treatment and survival for GAC patients. Efforts are needed to provide effective interventions for those whose educational status is adverse.
教育水平作为一个重要的社会经济因素，其对胃腺癌（GAC）患者预后的影响在很大程度上仍不清楚。我们旨在证明教育水平与 GAC 患者临床结局之间的关联。
我们纳入了来自 Surveillance, Epidemiology, and End Results 18 注册数据库的总共 30409 例 GAC 患者。教育程度、家庭收入、失业率、贫困率、保险状况和婚姻状况被选为综合分析的社会人口学变量。主要的统计方法是 Cox 和逻辑回归模型、Kaplan-Meier 曲线和亚组分析。
低教育水平与收入较低、失业率较高和贫困率较高相关（均<0.001）。多变量 Cox 分析表明，高教育水平与 GAC 患者的总生存率和癌症特异性生存率显著相关（均<0.001）。我们还在几乎所有临床和人口统计学亚组中证实了高教育水平与良好的生存结果相关。此外，化疗联合手术可以显著延长所有患者，包括 IV 期癌症患者的生存时间（均<0.001）。通过使用多变量逻辑模型，教育水平较高的县的患者接受化疗的可能性更高（<0.001）。相反，教育水平较低的县的患者接受化疗或手术的可能性较低（<0.001）。
教育水平被确定并证实为 GAC 患者治疗和生存的独立预测因素。需要努力为那些教育状况不利的人提供有效的干预措施。
