Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, TN, USA.
Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
JNCI Cancer Spectr. 2024 Nov 1;8(6). doi: 10.1093/jncics/pkae088.
Few studies have investigated the relationship between neighborhood vulnerability and health-related quality of life (HRQOL) in the childhood cancer population. This study evaluated the impact of neighborhood vulnerability on HRQOL among adult survivors of childhood cancer.
This cross-sectional study included 4393 adult survivors of childhood cancer from the St Jude Lifetime Cohort Study. At the baseline (2007-2020), HRQOL was assessed using the SF36v2's physical and mental components summaries (PCS and MCS). Neighborhood vulnerability was assessed using the overall, domain, and indicator-specific scores of the Social Vulnerability Index (SVI) and Minority Health SVI (MHSVI). Multivariable logistic regression was used to evaluate associations of neighborhood vulnerability (quartiles: Q1-Q4) with impaired HRQOL (1SD below the norm), adjusting for diagnosis, demographics, personal socioeconomic status (SES), lifestyle, and chronic health condition burden. Interactions of SVI and MHSVI with personal SES on impaired HRQOL were analyzed.
Among survivors, 51.9% were male, averaging 30.3 years of age at evaluation and 21.5 years since diagnosis. Comparing neighborhoods with higher vs lower vulnerability (Q4 vs Q1), overall (odds ratio [OR] = 1.60, 95% confidence interval [CI] = 1.19 to 2.16) and domain-specific vulnerability (socioeconomic: OR = 1.59, 95% CI = 1.18 to 2.15; household composition: OR = 1.54, 95% CI = 1.16 to 2.06; housing and transportation: OR = 1.33, 95% CI = 1.00 to 1.76; medical vulnerability: OR = 1.60, 95% CI = 1.22 to 2.09) were significantly associated with impaired PCS, but not MCS. Residing in neighborhoods lacking urgent care clinics was significantly associated with impaired PCS (OR = 1.39, 95% CI = 1.08 to 1.78). Having lower vs higher personal education and living in higher vulnerability neighborhoods were associated with more impaired PCS (Pinteraction = .021).
Specific aspects of neighborhood vulnerability increase the risk for impaired physical HRQOL. Addressing these neighborhood factors is essential to enhance the HRQOL of survivors.
很少有研究调查邻里脆弱性与儿童癌症患者健康相关生活质量（HRQOL）之间的关系。本研究评估了邻里脆弱性对儿童癌症成年幸存者 HRQOL 的影响。
本横断面研究纳入了来自圣裘德终身队列研究的 4393 名儿童癌症成年幸存者。在基线（2007-2020 年）时，使用 SF36v2 的身体和精神成分综合评分（PCS 和 MCS）评估 HRQOL。使用社会脆弱性指数（SVI）和少数族裔健康 SVI（MHSVI）的总体、领域和指标特定评分评估邻里脆弱性。使用多变量逻辑回归评估邻里脆弱性（四分位数：Q1-Q4）与 HRQOL 受损（低于正常值 1 个标准差）之间的关联，调整了诊断、人口统计学、个人社会经济地位（SES）、生活方式和慢性健康状况负担。分析了 SVI 和 MHSVI 与个人 SES 对 HRQOL 受损的交互作用。
在幸存者中，51.9%为男性，评估时平均年龄为 30.3 岁，诊断后平均年龄为 21.5 岁。与脆弱性较高的社区（Q4）相比，脆弱性较低的社区（Q1）的整体（比值比[OR] = 1.60，95%置信区间[CI] = 1.19 至 2.16）和特定领域的脆弱性（社会经济：OR = 1.59，95%CI = 1.18 至 2.15；家庭构成：OR = 1.54，95%CI = 1.16 至 2.06；住房和交通：OR = 1.33，95%CI = 1.00 至 1.76；医疗脆弱性：OR = 1.60，95%CI = 1.22 至 2.09）与 PCS 受损显著相关，但与 MCS 无关。居住在缺乏急诊诊所的社区与 PCS 受损显著相关（OR = 1.39，95%CI = 1.08 至 1.78）。与较高的个人教育程度相比，较低的个人教育程度和居住在脆弱性较高的社区与 PCS 受损程度更严重相关（P 交互作用=.021）。
邻里脆弱性的特定方面增加了身体 HRQOL 受损的风险。解决这些邻里因素对于提高幸存者的 HRQOL 至关重要。
