Impact of treatment and insurance on socioeconomic disparities in survival after adolescent and young adult Hodgkin lymphoma: A population-based study

Theresa H Keegan, Mindy C. Derouen, Helen M. Parsons, Christina A. Clarke, Debbie Goldberg, Christopher R. Flowers, Sally L. Glaser

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Previous studies documented racial/ethnic and socioeconomic disparities in survival after Hodgkin lymphoma among adolescents and young adults (AYA), but did not consider the influence of combined-modality treatment and health insurance. Methods: Data for 9,353 AYA patients ages 15 to 39 years when diagnosed with Hodgkin lymphoma during 1988 to 2011 were obtained from the California Cancer Registry. Using multivariate Cox proportional hazards regression, we examined the impact of sociodemographic characteristics [race/ethnicity, neighborhood socioeconomic status (SES), and health insurance], initial combined- modality treatment, and subsequent cancers on survival. Results: Over the 24-year study period, we observed improvements in Hodgkin lymphoma-specific survival by diagnostic period and differences in survival by race/ethnicity, neighborhood SES, and health insurance for a subset of more recently diagnosed patients (2001-2011). In multivariable analyses, Hodgkin lymphoma-specific survival was worse for Blacks than Whites with early-stage [HR: 1.68; 95% confidence interval (CI): 1.14-2.49] and late-stage disease (HR: 1.68; 95% CI, 1.17-2.41) and for Hispanics than Whites with late-stage disease (HR: 1.58; 95% CI, 1.22-2.04). AYAs diagnosed with early-stage disease experienced worse survival if they also resided in lower SES neighborhoods (HR: 2.06; 95% CI, 1.59-2.68). Furthermore, more recently diagnosed AYAs with public health insurance or who were uninsured experienced worse Hodgkin lymphoma- specific survival (HR: 2.08; 95% CI, 1.52-2.84). Conclusion: Our findings identify several subgroups of Hodgkin lymphoma patients at higher risk for Hodgkin lymphoma mortality. Impact: Identifying and reducing barriers to recommended treatment and surveillance in these AYAs at much higher risk of mortality is essential to ameliorating these survival disparities.

Original languageEnglish (US)
Pages (from-to)264-273
Number of pages10
JournalCancer Epidemiology Biomarkers and Prevention
Volume25
Issue number2
DOIs
StatePublished - Feb 1 2016

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Insurance
Hodgkin Disease
Young Adult
Survival
Health Insurance
Population
Confidence Intervals
Social Class
Therapeutics
Mortality
Hispanic Americans
Registries
Neoplasms
Public Health

ASJC Scopus subject areas

  • Epidemiology
  • Oncology

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Impact of treatment and insurance on socioeconomic disparities in survival after adolescent and young adult Hodgkin lymphoma : A population-based study. / Keegan, Theresa H; Derouen, Mindy C.; Parsons, Helen M.; Clarke, Christina A.; Goldberg, Debbie; Flowers, Christopher R.; Glaser, Sally L.

In: Cancer Epidemiology Biomarkers and Prevention, Vol. 25, No. 2, 01.02.2016, p. 264-273.

Research output: Contribution to journalArticle

Keegan, Theresa H ; Derouen, Mindy C. ; Parsons, Helen M. ; Clarke, Christina A. ; Goldberg, Debbie ; Flowers, Christopher R. ; Glaser, Sally L. / Impact of treatment and insurance on socioeconomic disparities in survival after adolescent and young adult Hodgkin lymphoma : A population-based study. In: Cancer Epidemiology Biomarkers and Prevention. 2016 ; Vol. 25, No. 2. pp. 264-273.
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abstract = "Background: Previous studies documented racial/ethnic and socioeconomic disparities in survival after Hodgkin lymphoma among adolescents and young adults (AYA), but did not consider the influence of combined-modality treatment and health insurance. Methods: Data for 9,353 AYA patients ages 15 to 39 years when diagnosed with Hodgkin lymphoma during 1988 to 2011 were obtained from the California Cancer Registry. Using multivariate Cox proportional hazards regression, we examined the impact of sociodemographic characteristics [race/ethnicity, neighborhood socioeconomic status (SES), and health insurance], initial combined- modality treatment, and subsequent cancers on survival. Results: Over the 24-year study period, we observed improvements in Hodgkin lymphoma-specific survival by diagnostic period and differences in survival by race/ethnicity, neighborhood SES, and health insurance for a subset of more recently diagnosed patients (2001-2011). In multivariable analyses, Hodgkin lymphoma-specific survival was worse for Blacks than Whites with early-stage [HR: 1.68; 95{\%} confidence interval (CI): 1.14-2.49] and late-stage disease (HR: 1.68; 95{\%} CI, 1.17-2.41) and for Hispanics than Whites with late-stage disease (HR: 1.58; 95{\%} CI, 1.22-2.04). AYAs diagnosed with early-stage disease experienced worse survival if they also resided in lower SES neighborhoods (HR: 2.06; 95{\%} CI, 1.59-2.68). Furthermore, more recently diagnosed AYAs with public health insurance or who were uninsured experienced worse Hodgkin lymphoma- specific survival (HR: 2.08; 95{\%} CI, 1.52-2.84). Conclusion: Our findings identify several subgroups of Hodgkin lymphoma patients at higher risk for Hodgkin lymphoma mortality. Impact: Identifying and reducing barriers to recommended treatment and surveillance in these AYAs at much higher risk of mortality is essential to ameliorating these survival disparities.",
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AU - Flowers, Christopher R.

AU - Glaser, Sally L.

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