Tortolero Guillermo A, Betts Andrea C, Suragh Tiffany A, Pruitt Sandi L, Roth Michael E, Murphy Caitlin C
Department of Epidemiology, University of Texas Health Science Center at Houston, School of Public Health, Houston, TX, USA.
Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, School of Public Health, Dallas, TX, USA.
J Natl Cancer Inst. 2024 Dec 1;116(12):2003-2008. doi: 10.1093/jnci/djae170.
Evidence suggests neighborhood-level factors contribute to cancer outcomes, although most research focuses on pediatric and adult populations. Using population-based data from the Texas Cancer Registry, we examined neighborhood-level social vulnerability, a composite measure of 14 census tract-level social risk factors, and survival among 112 142 adolescents and young adults with cancer (AYAs, age 15-39 years). We estimated 1-, 5-, and 10-year overall survival by quintile of social vulnerability and used Cox proportional hazards models (2-sided significance testing) to estimate the association between social vulnerability and all-cause mortality. Survival decreased as social vulnerability increased; for example, 5-year survival was 86.5% (95% confidence interval [CI] = 85.1 to 87.0) in the least vulnerable quintile compared to 74.0% (95% CI = 73.4 to 74.5) in the most vulnerable quintile. Social vulnerability was associated with all-cause mortality in adjusted models (highest vs lowest quintile: adjusted hazard ratio [aHR] = 1.55, 95% CI = 1.48 to 1.63). Achieving equity in AYAs' survival requires interventions to address neighborhood disparities.
有证据表明，邻里层面的因素会影响癌症治疗结果，尽管大多数研究集中在儿童和成人人群。利用得克萨斯癌症登记处的基于人群的数据，我们研究了邻里层面的社会脆弱性，这是一种对14个人口普查区层面的社会风险因素的综合衡量指标，并研究了112142名青少年和青年癌症患者（年龄在15至39岁之间）的生存率。我们按社会脆弱性五分位数估计了1年、5年和10年的总生存率，并使用Cox比例风险模型（双侧显著性检验）来估计社会脆弱性与全因死亡率之间的关联。生存率随着社会脆弱性的增加而降低；例如，最不易受影响的五分位数中的5年生存率为86.5%（95%置信区间[CI]=85.1至87.0），而最易受影响的五分位数中的5年生存率为74.0%（95%CI=73.4至74.5）。在调整后的模型中，社会脆弱性与全因死亡率相关（最高五分位数与最低五分位数相比：调整后风险比[aHR]=1.55，95%CI=1.48至1.63）。要实现青少年和青年癌症患者生存率的公平，需要采取干预措施来解决邻里之间的差异。
