Effects of marital status and economic resources on survival after cancer: A population-based study

Scarlett Lin Gomez, Susan Hurley, Alison J. Canchola, Theresa H Keegan, Iona Cheng, James D. Murphy, Christina A. Clarke, Sally L. Glaser, María Elena Martínez

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

BACKGROUND Although married cancer patients have more favorable survival than unmarried patients, reasons underlying this association are not fully understood. The authors evaluated the role of economic resources, including health insurance status and neighborhood socioeconomic status (nSES), in a large California cohort. METHODS From the California Cancer Registry, we identified 783,167 cancer patients (386,607 deaths) who were diagnosed during 2000 through 2009 with a first primary, invasive cancer of the 10 most common sites of cancer-related death for each sex and were followed through 2012. Age-stratified and stage-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality associated with marital status, adjusted for cancer site, race/ethnicity, and treatment. RESULTS Compared with married patients, unmarried patients had an elevated risk of mortality that was higher among males (HR, 1.27; 95% CI, 1.26-1.29) than among females (HR, 1.19; 95% CI, 1.18-1.20; Pinteraction <.001). Adjustment for insurance status and nSES reduced the marital status HRs to 1.22 for males and 1.15 for females. There was some evidence of synergistic effects of marital status, insurance, and nSES, with relatively higher risks observed for unmarried status among those who were under-insured and living in high nSES areas compared with those who were under-insured and living in low nSES areas (Pinteraction = 6.8 × 10-9 among males and 8.2 × 10-8 among females). CONCLUSIONS The worse survival of unmarried than married cancer patients appears to be minimally explained by differences in economic resources.

Original languageEnglish (US)
Pages (from-to)1618-1625
Number of pages8
JournalCancer
Volume122
Issue number10
DOIs
StatePublished - May 15 2016

Fingerprint

Marital Status
Economics
Social Class
Survival
Population
Neoplasms
Insurance Coverage
Confidence Intervals
Mortality
Health Insurance
Insurance
Proportional Hazards Models
Health Status
Registries

Keywords

  • health insurance
  • marriage
  • mortality
  • neighborhood socioeconomic status
  • race/ethnicity

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Gomez, S. L., Hurley, S., Canchola, A. J., Keegan, T. H., Cheng, I., Murphy, J. D., ... Martínez, M. E. (2016). Effects of marital status and economic resources on survival after cancer: A population-based study. Cancer, 122(10), 1618-1625. https://doi.org/10.1002/cncr.29885

Effects of marital status and economic resources on survival after cancer : A population-based study. / Gomez, Scarlett Lin; Hurley, Susan; Canchola, Alison J.; Keegan, Theresa H; Cheng, Iona; Murphy, James D.; Clarke, Christina A.; Glaser, Sally L.; Martínez, María Elena.

In: Cancer, Vol. 122, No. 10, 15.05.2016, p. 1618-1625.

Research output: Contribution to journalArticle

Gomez, SL, Hurley, S, Canchola, AJ, Keegan, TH, Cheng, I, Murphy, JD, Clarke, CA, Glaser, SL & Martínez, ME 2016, 'Effects of marital status and economic resources on survival after cancer: A population-based study', Cancer, vol. 122, no. 10, pp. 1618-1625. https://doi.org/10.1002/cncr.29885
Gomez, Scarlett Lin ; Hurley, Susan ; Canchola, Alison J. ; Keegan, Theresa H ; Cheng, Iona ; Murphy, James D. ; Clarke, Christina A. ; Glaser, Sally L. ; Martínez, María Elena. / Effects of marital status and economic resources on survival after cancer : A population-based study. In: Cancer. 2016 ; Vol. 122, No. 10. pp. 1618-1625.
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abstract = "BACKGROUND Although married cancer patients have more favorable survival than unmarried patients, reasons underlying this association are not fully understood. The authors evaluated the role of economic resources, including health insurance status and neighborhood socioeconomic status (nSES), in a large California cohort. METHODS From the California Cancer Registry, we identified 783,167 cancer patients (386,607 deaths) who were diagnosed during 2000 through 2009 with a first primary, invasive cancer of the 10 most common sites of cancer-related death for each sex and were followed through 2012. Age-stratified and stage-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95{\%} confidence intervals (95{\%} CIs) for all-cause mortality associated with marital status, adjusted for cancer site, race/ethnicity, and treatment. RESULTS Compared with married patients, unmarried patients had an elevated risk of mortality that was higher among males (HR, 1.27; 95{\%} CI, 1.26-1.29) than among females (HR, 1.19; 95{\%} CI, 1.18-1.20; Pinteraction <.001). Adjustment for insurance status and nSES reduced the marital status HRs to 1.22 for males and 1.15 for females. There was some evidence of synergistic effects of marital status, insurance, and nSES, with relatively higher risks observed for unmarried status among those who were under-insured and living in high nSES areas compared with those who were under-insured and living in low nSES areas (Pinteraction = 6.8 × 10-9 among males and 8.2 × 10-8 among females). CONCLUSIONS The worse survival of unmarried than married cancer patients appears to be minimally explained by differences in economic resources.",
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AU - Gomez, Scarlett Lin

AU - Hurley, Susan

AU - Canchola, Alison J.

AU - Keegan, Theresa H

AU - Cheng, Iona

AU - Murphy, James D.

AU - Clarke, Christina A.

AU - Glaser, Sally L.

AU - Martínez, María Elena

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N2 - BACKGROUND Although married cancer patients have more favorable survival than unmarried patients, reasons underlying this association are not fully understood. The authors evaluated the role of economic resources, including health insurance status and neighborhood socioeconomic status (nSES), in a large California cohort. METHODS From the California Cancer Registry, we identified 783,167 cancer patients (386,607 deaths) who were diagnosed during 2000 through 2009 with a first primary, invasive cancer of the 10 most common sites of cancer-related death for each sex and were followed through 2012. Age-stratified and stage-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality associated with marital status, adjusted for cancer site, race/ethnicity, and treatment. RESULTS Compared with married patients, unmarried patients had an elevated risk of mortality that was higher among males (HR, 1.27; 95% CI, 1.26-1.29) than among females (HR, 1.19; 95% CI, 1.18-1.20; Pinteraction <.001). Adjustment for insurance status and nSES reduced the marital status HRs to 1.22 for males and 1.15 for females. There was some evidence of synergistic effects of marital status, insurance, and nSES, with relatively higher risks observed for unmarried status among those who were under-insured and living in high nSES areas compared with those who were under-insured and living in low nSES areas (Pinteraction = 6.8 × 10-9 among males and 8.2 × 10-8 among females). CONCLUSIONS The worse survival of unmarried than married cancer patients appears to be minimally explained by differences in economic resources.

AB - BACKGROUND Although married cancer patients have more favorable survival than unmarried patients, reasons underlying this association are not fully understood. The authors evaluated the role of economic resources, including health insurance status and neighborhood socioeconomic status (nSES), in a large California cohort. METHODS From the California Cancer Registry, we identified 783,167 cancer patients (386,607 deaths) who were diagnosed during 2000 through 2009 with a first primary, invasive cancer of the 10 most common sites of cancer-related death for each sex and were followed through 2012. Age-stratified and stage-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality associated with marital status, adjusted for cancer site, race/ethnicity, and treatment. RESULTS Compared with married patients, unmarried patients had an elevated risk of mortality that was higher among males (HR, 1.27; 95% CI, 1.26-1.29) than among females (HR, 1.19; 95% CI, 1.18-1.20; Pinteraction <.001). Adjustment for insurance status and nSES reduced the marital status HRs to 1.22 for males and 1.15 for females. There was some evidence of synergistic effects of marital status, insurance, and nSES, with relatively higher risks observed for unmarried status among those who were under-insured and living in high nSES areas compared with those who were under-insured and living in low nSES areas (Pinteraction = 6.8 × 10-9 among males and 8.2 × 10-8 among females). CONCLUSIONS The worse survival of unmarried than married cancer patients appears to be minimally explained by differences in economic resources.

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KW - mortality

KW - neighborhood socioeconomic status

KW - race/ethnicity

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