Office of Research and Scholarship, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Southern California Permanente Medical Group, Pasadena, CA.
J Natl Compr Canc Netw. 2024 Sep;22(7):447-453. doi: 10.6004/jnccn.2024.7027.
Adolescent and young adult (AYA) patients with cancer have historically been understudied. Few studies have examined survival disparities associated with racial/ethnic and socioeconomic status (SES) and do not account for the influence of insurance status and access to care. We evaluated the association of SES and race/ethnicity with overall mortality for AYA patients who were members of an integrated health system with relatively equal access to care.
AYA patients diagnosed with the 15 most common cancer types during 2010 through 2018 at Kaiser Permanente Southern California were included. Neighborhood Deprivation Index (NDI) quartile (Q1: least deprived; Q4: most deprived) was used as a measure of SES. Mortality rate per 1,000 person-years was calculated for each racial/ethnic and NDI subgroup. Multivariable Cox model was used to estimate hazard ratios (HRs) for all-cause mortality adjusting for sex, age and stage at diagnosis, cancer type, race/ethnicity, and NDI.
Data for 6,379 patients were tracked for a maximum of 10 years. Crude mortality rates were higher among non-White racial/ethnic patients compared with non-Hispanic (NH)-White patients. In the Cox model, Hispanic (HR, 1.31; P=.004) and NH-Black (HR, 1.34; P=.05) patients experienced significantly higher all-cause mortality risk compared with NH-White patients. Patients from more deprived neighborhoods had higher mortality risk. In the Cox model, there was no significant difference in all-cause mortality between Q1 and Q2 through Q4 (Q2: HR, 0.88; P=.26, Q3: HR, 0.94; P=.56, and Q4: HR, 0.95; P=.70).
For AYAs with cancer with similar access to care, Hispanic and NH-Black patients have higher risk of all-cause mortality than NH-White patients, whereas no significant SES-associated survival disparities were observed. These findings warrant further investigation, awareness, and intervention to address inequities in cancer care among vulnerable populations.
青少年和年轻成人（AYA）癌症患者既往研究较少。少数研究调查了与种族/民族和社会经济地位（SES）相关的生存差异，且未考虑保险状况和获得医疗服务的影响。我们评估了 SES 和种族/民族与参加具有相对平等获得医疗服务机会的综合卫生系统的 AYA 患者的全因死亡率之间的关联。
纳入 2010 年至 2018 年期间在 Kaiser Permanente Southern California 被诊断患有 15 种最常见癌症类型的 AYA 患者。采用邻里剥夺指数（NDI）四分位数（Q1：最不贫困；Q4：最贫困）作为 SES 的衡量指标。计算每个种族/民族和 NDI亚组每千人年的死亡率。多变量 Cox 模型用于调整性别、年龄和诊断时的分期、癌症类型、种族/民族和 NDI 后，估算全因死亡率的危险比（HR）。
对 6379 例患者的数据进行了最长 10 年的跟踪。与非西班牙裔白人（NH-White）患者相比，非白人种族/民族患者的粗死亡率更高。在 Cox 模型中，西班牙裔（HR，1.31；P=0.004）和 NH-黑人（HR，1.34；P=0.05）患者的全因死亡风险显著高于 NH-White 患者。来自贫困程度较高的邻里的患者死亡率更高。在 Cox 模型中，Q1 至 Q4 组之间全因死亡率无显著差异（Q2：HR，0.88；P=0.26，Q3：HR，0.94；P=0.56，Q4：HR，0.95；P=0.70）。
在获得相似医疗服务的 AYA 癌症患者中，与 NH-White 患者相比，西班牙裔和 NH-黑人患者的全因死亡风险更高，而 SES 相关的生存差异无显著差异。这些发现值得进一步调查、关注和干预，以解决弱势群体癌症护理方面的不平等问题。
