Center for Healthy Aging, Self-Management and Complex Care, Ohio State University College of Nursing, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA.
Department of Biomedical Informatics, Ohio State University College of Medicine, Ohio State University- James: Cancer Treatment and Research Center, Columbus, OH, 43210, USA.
J Gastrointest Cancer. 2024 Sep;55(3):1179-1189. doi: 10.1007/s12029-024-01070-2. Epub 2024 May 31.
This study aimed to understand how health-related quality of life (HRQoL) differs by race/ethnicity in colorectal (CRC) survivors. We aimed to 1) examine racial/ethnic disparities in HRQoL, and 2) explore the roles of social determinants of health (SDOH) risk factors for HRQoL differ by racial/ethnic groups.
In 2,492 adult CRC survivors using Behavioral Risk Factor Surveillance System (BRFSS) survey data (from 2014 to 2021, excluding 2015 due to the absence of CRC data), we used the Centers for Disease Control and Prevention (CDC) HRQoL measure, categorized into "better" and "poor." Multivariate logistic regressions with prevalence risk (PR) were employed for our primary analyses.
Compared with non-Hispanic Whites (NHW), non-Hispanic Blacks (NHB) (PR = 0.61, p = .045) and Hispanics (PR = 0.32, p < .001) reported worse HRQoL in adjusted models. In adjusted models, unemployed/retired and low-income levels were common risk factors for worse HRQoL across all comparison groups (NHW, NHB, non-Hispanic other races, and Hispanics). Other SDOH associated with worse HRQoL include divorced/widowed/never married marital status (non-Hispanic other races and Hispanics), living in rural areas (NHW and NHB), and low education levels (NHB and Hispanics). Marital status, education, and employment status significantly interacted with race/ethnicity, with the strongest interaction between Hispanics and education (PR = 2.45, p = .045) in adjusted models.
These findings highlight the need for culturally tailored interventions targeting modifiable factors (e.g., social and financial supports, health literacy), specifically for socially vulnerable CRC survivors, to address the disparities in HRQoL among different racial/ethnic groups.
本研究旨在了解在结直肠癌（CRC）幸存者中，健康相关生活质量（HRQoL）因种族/民族而异的情况。我们旨在：1）检查 HRQoL 方面的种族/民族差异，2）探讨社会决定健康因素（SDOH）的作用，这些因素对 HRQoL 的影响因种族/民族群体而异。
我们使用行为风险因素监测系统（BRFSS）调查数据（2014 年至 2021 年，不包括 2015 年，因为当时没有 CRC 数据），对 2492 名成年 CRC 幸存者进行了分析，使用了疾病控制和预防中心（CDC）的 HRQoL 衡量标准，分为“更好”和“较差”两类。我们主要采用多变量逻辑回归分析，采用患病率风险（PR）进行分析。
与非西班牙裔白人（NHW）相比，非西班牙裔黑人（NHB）（PR=0.61，p=0.045）和西班牙裔（PR=0.32，p<.001）报告的 HRQoL 更差。在调整后的模型中，失业/退休和低收入水平是所有比较组（NHW、NHB、非西班牙裔其他种族和西班牙裔）中 HRQoL 较差的常见危险因素。与较差的 HRQoL 相关的其他 SDOH 因素包括离婚/丧偶/未婚的婚姻状况（非西班牙裔其他种族和西班牙裔）、居住在农村地区（NHW 和 NHB）和低教育水平（NHB 和西班牙裔）。婚姻状况、教育程度和就业状况与种族/民族显著相互作用，在调整后的模型中，西班牙裔和教育之间的相互作用最强（PR=2.45，p=0.045）。
这些发现强调需要针对不同种族/民族群体的 HRQoL 差异，针对可改变的因素（例如社会和经济支持、健康素养）进行文化上合适的干预措施，特别是针对社会弱势群体的 CRC 幸存者。
