Sociodemographic disparities in the occurrence of medical conditions among adolescent and young adult Hodgkin lymphoma survivors

Theresa H Keegan, Qian Li, Amy Steele, Elysia Alvarez, Ann Brunson, Christopher R. Flowers, Sally L. Glaser, Theodore Wun

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: Hodgkin lymphoma (HL) survivors experience high risks of second cancers and cardiovascular disease, but no studies have considered whether the occurrence of these and other medical conditions differ by sociodemographic factors in adolescent and young adult (AYA) survivors. Methods: Data for 5,085 patients aged 15–39 when diagnosed with HL during 1996–2012 and surviving ≥ 2 years were obtained from the California Cancer Registry and linked to hospitalization data. We examined the impact of race/ethnicity, neighborhood socioeconomic status (SES), and health insurance on the occurrence of medical conditions (≥ 2 years after diagnosis) and the impact of medical conditions on survival using multivariable Cox proportional hazards regression. Results: Twenty-six percent of AYAs experienced at least one medical condition and 15% had ≥ 2 medical conditions after treatment for HL. In multivariable analyses, Black HL survivors had a higher likelihood (vs. non-Hispanic Whites) of endocrine [hazard ratio (HR) = 1.37, 95% confidence interval (CI) 1.05–1.78] and circulatory system diseases (HR = 1.58, CI 1.17–2.14); Hispanics had a higher likelihood of endocrine diseases [HR = 1.24 (1.04–1.48)]. AYAs with public or no insurance (vs. private/military) had higher likelihood of circulatory system diseases, respiratory system diseases, chronic kidney disease/renal failure, liver disease, and endocrine diseases. AYAs residing in low SES neighborhoods (vs. high) had higher likelihood of respiratory system and endocrine diseases. AYAs with these medical conditions or second cancers had an over twofold increased risk of death. Conclusion: Strategies to improve health care utilization for surveillance and secondary prevention among AYA HL survivors at increased risk of medical conditions may improve outcomes.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalCancer Causes and Control
DOIs
StateAccepted/In press - Apr 13 2018

Fingerprint

Hodgkin Disease
Survivors
Young Adult
Endocrine System Diseases
Second Primary Neoplasms
Cardiovascular System
Social Class
Respiratory System
Patient Acceptance of Health Care
Confidence Intervals
Health Insurance
Secondary Prevention
Insurance
Chronic Renal Insufficiency
Hispanic Americans
Renal Insufficiency
Registries
Liver Diseases
Hospitalization
Cardiovascular Diseases

Keywords

  • Adolescent
  • Circulatory system
  • Endocrine system
  • Hodgkin lymphoma
  • Insurance
  • Race/ethnicity
  • Respiratory system
  • Second cancer
  • Young adult

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Sociodemographic disparities in the occurrence of medical conditions among adolescent and young adult Hodgkin lymphoma survivors. / Keegan, Theresa H; Li, Qian; Steele, Amy; Alvarez, Elysia; Brunson, Ann; Flowers, Christopher R.; Glaser, Sally L.; Wun, Theodore.

In: Cancer Causes and Control, 13.04.2018, p. 1-11.

Research output: Contribution to journalArticle

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abstract = "Purpose: Hodgkin lymphoma (HL) survivors experience high risks of second cancers and cardiovascular disease, but no studies have considered whether the occurrence of these and other medical conditions differ by sociodemographic factors in adolescent and young adult (AYA) survivors. Methods: Data for 5,085 patients aged 15–39 when diagnosed with HL during 1996–2012 and surviving ≥ 2 years were obtained from the California Cancer Registry and linked to hospitalization data. We examined the impact of race/ethnicity, neighborhood socioeconomic status (SES), and health insurance on the occurrence of medical conditions (≥ 2 years after diagnosis) and the impact of medical conditions on survival using multivariable Cox proportional hazards regression. Results: Twenty-six percent of AYAs experienced at least one medical condition and 15{\%} had ≥ 2 medical conditions after treatment for HL. In multivariable analyses, Black HL survivors had a higher likelihood (vs. non-Hispanic Whites) of endocrine [hazard ratio (HR) = 1.37, 95{\%} confidence interval (CI) 1.05–1.78] and circulatory system diseases (HR = 1.58, CI 1.17–2.14); Hispanics had a higher likelihood of endocrine diseases [HR = 1.24 (1.04–1.48)]. AYAs with public or no insurance (vs. private/military) had higher likelihood of circulatory system diseases, respiratory system diseases, chronic kidney disease/renal failure, liver disease, and endocrine diseases. AYAs residing in low SES neighborhoods (vs. high) had higher likelihood of respiratory system and endocrine diseases. AYAs with these medical conditions or second cancers had an over twofold increased risk of death. Conclusion: Strategies to improve health care utilization for surveillance and secondary prevention among AYA HL survivors at increased risk of medical conditions may improve outcomes.",
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T1 - Sociodemographic disparities in the occurrence of medical conditions among adolescent and young adult Hodgkin lymphoma survivors

AU - Keegan, Theresa H

AU - Li, Qian

AU - Steele, Amy

AU - Alvarez, Elysia

AU - Brunson, Ann

AU - Flowers, Christopher R.

AU - Glaser, Sally L.

AU - Wun, Theodore

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N2 - Purpose: Hodgkin lymphoma (HL) survivors experience high risks of second cancers and cardiovascular disease, but no studies have considered whether the occurrence of these and other medical conditions differ by sociodemographic factors in adolescent and young adult (AYA) survivors. Methods: Data for 5,085 patients aged 15–39 when diagnosed with HL during 1996–2012 and surviving ≥ 2 years were obtained from the California Cancer Registry and linked to hospitalization data. We examined the impact of race/ethnicity, neighborhood socioeconomic status (SES), and health insurance on the occurrence of medical conditions (≥ 2 years after diagnosis) and the impact of medical conditions on survival using multivariable Cox proportional hazards regression. Results: Twenty-six percent of AYAs experienced at least one medical condition and 15% had ≥ 2 medical conditions after treatment for HL. In multivariable analyses, Black HL survivors had a higher likelihood (vs. non-Hispanic Whites) of endocrine [hazard ratio (HR) = 1.37, 95% confidence interval (CI) 1.05–1.78] and circulatory system diseases (HR = 1.58, CI 1.17–2.14); Hispanics had a higher likelihood of endocrine diseases [HR = 1.24 (1.04–1.48)]. AYAs with public or no insurance (vs. private/military) had higher likelihood of circulatory system diseases, respiratory system diseases, chronic kidney disease/renal failure, liver disease, and endocrine diseases. AYAs residing in low SES neighborhoods (vs. high) had higher likelihood of respiratory system and endocrine diseases. AYAs with these medical conditions or second cancers had an over twofold increased risk of death. Conclusion: Strategies to improve health care utilization for surveillance and secondary prevention among AYA HL survivors at increased risk of medical conditions may improve outcomes.

AB - Purpose: Hodgkin lymphoma (HL) survivors experience high risks of second cancers and cardiovascular disease, but no studies have considered whether the occurrence of these and other medical conditions differ by sociodemographic factors in adolescent and young adult (AYA) survivors. Methods: Data for 5,085 patients aged 15–39 when diagnosed with HL during 1996–2012 and surviving ≥ 2 years were obtained from the California Cancer Registry and linked to hospitalization data. We examined the impact of race/ethnicity, neighborhood socioeconomic status (SES), and health insurance on the occurrence of medical conditions (≥ 2 years after diagnosis) and the impact of medical conditions on survival using multivariable Cox proportional hazards regression. Results: Twenty-six percent of AYAs experienced at least one medical condition and 15% had ≥ 2 medical conditions after treatment for HL. In multivariable analyses, Black HL survivors had a higher likelihood (vs. non-Hispanic Whites) of endocrine [hazard ratio (HR) = 1.37, 95% confidence interval (CI) 1.05–1.78] and circulatory system diseases (HR = 1.58, CI 1.17–2.14); Hispanics had a higher likelihood of endocrine diseases [HR = 1.24 (1.04–1.48)]. AYAs with public or no insurance (vs. private/military) had higher likelihood of circulatory system diseases, respiratory system diseases, chronic kidney disease/renal failure, liver disease, and endocrine diseases. AYAs residing in low SES neighborhoods (vs. high) had higher likelihood of respiratory system and endocrine diseases. AYAs with these medical conditions or second cancers had an over twofold increased risk of death. Conclusion: Strategies to improve health care utilization for surveillance and secondary prevention among AYA HL survivors at increased risk of medical conditions may improve outcomes.

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KW - Circulatory system

KW - Endocrine system

KW - Hodgkin lymphoma

KW - Insurance

KW - Race/ethnicity

KW - Respiratory system

KW - Second cancer

KW - Young adult

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