Alnajar Ahmed, Kareff Samuel A, Razi Syed S, Rao J Sunil, Nguyen Dao M, Villamizar Nestor, Rodriguez Estelamari
University of Miami Miller School of Medicine, Miami, Florida.
Hackensack Meridian Health, Edison, New Jersey.
Ann Thorac Surg Short Rep. 2023 Jun 14;1(4):548-552. doi: 10.1016/j.atssr.2023.05.020. eCollection 2023 Dec.
Patients with malignant pleural mesothelioma (MPM) have a high mortality risk, even after optimal management and accounting for differences in comorbidities. We aimed to assess the overall survival of patients with operable MPM based on social determinants of health (SDH). We hypothesized that an SDH score can predict patients with poorer overall survival despite optimal management.
This study used a retrospective analysis of the National Cancer Database from 2004 to 2017. Adult patients with clinical stage I-IIIA MPM were included. Based on patients' personal and geographic characteristics, we constructed an SDH score index that identifies patients of socioeconomic disadvantage by the following variables: income, education, geography, and hospital types within 250 miles. We performed a survival analysis using the Kaplan-Meier method as well as univariable and multivariable Cox regression models.
Higher composite SDH scores demonstrated worse outcomes. Overall increased disadvantage increased the risk of mortality by 21% (hazard ratio [HR], 1.21; CI, 1.12-1.30), with a higher increase of 57% for score ≥2 (HR,1.57; CI, 1.36-1.81). After accounting for age, stage, comorbidities, multimodal therapy, and hospital volume and type, the SDH score index remained statistically significant, with a 29% increased risk of mortality for score ≥2 compared with ≤1 (HR, 1.29; CI, 1.10-1.50). Curative surgery with chemotherapy reduced mortality risk by 29% (HR, 0.71; CI, 0.62-0.81) after adjustment for patients' SDH scores and other relevant factors.
Various SDH factors affect survival outcomes independently of treatment modality and patient characteristics. This SDH composite score could help identify patients with socioeconomic disadvantages at risk for suboptimal survival outcomes.
恶性胸膜间皮瘤（MPM）患者即使经过最佳治疗并考虑了合并症差异，仍有较高的死亡风险。我们旨在基于健康的社会决定因素（SDH）评估可手术MPM患者的总生存期。我们假设SDH评分可以预测即使经过最佳治疗总生存期仍较差的患者。
本研究对2004年至2017年的国家癌症数据库进行回顾性分析。纳入临床I-IIIA期MPM的成年患者。基于患者的个人和地理特征，我们构建了一个SDH评分指数，通过以下变量识别社会经济处于不利地位的患者：收入、教育程度、地理位置以及250英里范围内的医院类型。我们使用Kaplan-Meier方法以及单变量和多变量Cox回归模型进行生存分析。
较高的综合SDH评分显示出更差的结果。总体不利因素增加使死亡风险增加21%（风险比[HR]，1.21；可信区间[CI]，1.12-1.30），评分≥2时增加幅度更高，为57%（HR，1.57；CI，1.36-1.81）。在考虑年龄、分期、合并症、多模式治疗以及医院规模和类型后，SDH评分指数仍具有统计学意义，评分≥2与≤1相比，死亡风险增加29%（HR，1.29；CI，1.10-1.50）。在对患者的SDH评分和其他相关因素进行调整后，化疗联合根治性手术使死亡风险降低29%（HR，0.71；CI，0.62-0.81）。
各种SDH因素独立于治疗方式和患者特征影响生存结果。这个SDH综合评分有助于识别社会经济处于不利地位、生存结果可能不佳的患者。
