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Ledenko M, Patel T. Association of county level poverty with mortality from primary liver cancers. Cancer Med 2024; 13:e7463. [PMID: 39096101 PMCID: PMC11297446 DOI: 10.1002/cam4.7463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 05/30/2024] [Accepted: 06/24/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The highly variable occurrence of primary liver cancers across the United States emphasize the relevance of location-based factors. Social determinants such as income, educational attainment, housing, and other factors may contribute to regional variations in outcomes. To evaluate their impact, this study identified and analyzed clusters of high mortality from primary liver cancers and the association of location-based determinants with mortality across the contiguous United States. METHODS A geospatial analysis of age-adjusted incidence and standardized mortality rates from primary liver cancers from 2000 to 2020 was performed. Local indicators of spatial association identified hot-spots, clusters of counties with significantly higher mortality. Temporal analysis of locations with persistent poverty, defined as high (>20%) poverty for at least 30 years, was performed. Social determinants were analyzed individually or globally using composite measures such as the social vulnerability index or social deprivation index. Disparities in county level social determinants between hot-spots and non-hot-spots were analyzed by univariate and multivariate logistic regression. RESULTS There are distinct clusters of liver cancer incidence and mortality, with hotspots in east Texas and Louisiana. The percentage of people living below the poverty line or Hispanics had a significantly higher odds ratio for being in the top quintile for mortality rates in comparison to other quintiles and were highly connected with mortality rates. Current and persistent poverty were both associated with an evolution from non-hotspots to new hotspots of mortality. Hotspots were predominantly associated with locations with significant levels of socioeconomic vulnerability or deprivation. CONCLUSIONS Poverty at a county level is associated with mortality from primary liver cancer and clusters of higher mortality. These findings emphasize the importance of addressing poverty and related socio-economic determinants as modifiable factors in public health policies and interventions aimed at reducing mortality from primary liver cancers.
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Affiliation(s)
- Matthew Ledenko
- Division of Gastroenterology and Hepatology, Department of TransplantationMayo Clinic FloridaJacksonvilleFloridaUSA
| | - Tushar Patel
- Division of Gastroenterology and Hepatology, Department of TransplantationMayo Clinic FloridaJacksonvilleFloridaUSA
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2
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Arnett A, Siegel DA, Dai S, Thompson TD, Foster J, di Pierro EJ, Momin B, Lupo PJ, Heczey A. Incidence and survival of pediatric and adult hepatocellular carcinoma, United States, 2001-2020. Cancer Epidemiol 2024; 92:102610. [PMID: 38986355 DOI: 10.1016/j.canep.2024.102610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Hepatocellular carcinoma accounts for approximately 80 % of liver neoplasms. Globally, hepatocellular carcinoma ranks as the third most lethal cancer, with the number of deaths expected to further increase by 2040. In adults, disparities in incidence and survival are well described while pediatric epidemiology is not well characterized. We describe incidence and survival for pediatric (ages 0-19 years) hepatocellular carcinoma cases and compare these measures to adults (ages ≥ 20 years) diagnosed with hepatocellular carcinoma. METHODS We assessed incidence data from the US Cancer Statistics database during 2003-2020 and 5-year survival from the National Program of Cancer Registries during 2001-2019. Incidence trends were determined by annual percent change (APC) and average APC (AAPC) using joinpoint regression. Five-year survival was evaluated by relative survival, and all-cause survival was estimated using multivariate Cox modeling. Corresponding 95 % confidence intervals (CI) were calculated for all analyses. RESULTS Incidence rate per 100,000 persons was 0.056 (95 %CI:0.052-0.060) for pediatric cases and 7.793 (7.767-7.819) for adults. Incidence was stable in the pediatric population (0.3 AAPC, - 1.1 to 1.7). In contrast, after periods of increase, incidence declined in adults after 2015 (-1.5 APC). Relative survival increased over time for both pediatric and adult ages and was higher for children and adolescents (46.4 %, 95 %CI:42.4-50.3) than adults (20.7 %, 95 %CI:20.5-20.9). Regression modeling showed that non-Hispanic Black race and ethnicity was associated with higher risk of death in children and adolescents (1.48, 95 %CI:1.07-2.05) and adults (1.11, 95 %CI:1.09-1.12) compared to non-Hispanic white race and ethnicity. CONCLUSIONS Between 2003 and 2020 in the United States, pediatric incidence was stable while incidence in adults began to decline after 2015. Survival was higher across all stages for children and adolescents compared to adults. Non-Hispanic Black race and ethnicity showed a higher risk of death for both age groups. Further studies could explore the factors that influence these outcome disparities.
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Affiliation(s)
- Azlann Arnett
- Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX, United States; Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - David A Siegel
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Shifan Dai
- Cyberdata Technologies, Inc., Herndon, VA, United States
| | - Trevor D Thompson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jennifer Foster
- Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX, United States; Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Erika J di Pierro
- Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX, United States; Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Behnoosh Momin
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Philip J Lupo
- Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX, United States; Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States; Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Andras Heczey
- Cancer and Hematology Centers, Texas Children's Hospital, Houston, TX, United States; Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.
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3
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Feng F, Zhao Y. Hepatocellular Carcinoma: Prevention, Diagnosis, and Treatment. Med Princ Pract 2024:1-10. [PMID: 38772352 DOI: 10.1159/000539349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
Hepatocellular carcinoma (HCC), the most prevalent form of liver cancer globally, poses a substantial health burden. Influenced by risk factors such as hepatitis B or C virus infections, chronic consumption of alcohol, and metabolic dysfunction, its exact etiology likely involves a complex interplay between viral infection, hepatocyte mutations, and chronic liver diseases like cirrhosis and metabolic dysfunction-associated steatohepatitis, and demographic variables like sex, race, and age. Disease stage significantly impacts the prognosis of HCC. There is significant potential for life-saving and socioeconomic benefits through the implementation of surveillance programs and the introduction of low-cost screening measures for high-risk groups; these screening measures include ultrasound imaging and blood tests. Treatment options for HCC encompass liver resection, transplantation, transarterial chemoembolization, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Despite therapeutic advances, treating advanced HCC remains challenging, emphasizing the need for continued efforts in prevention, early detection, and development of treatments to improve prognosis and long-term survival.
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Affiliation(s)
- Fei Feng
- Ultrasound Medicine, The First Hospital of Lanzhou University, Lanzhou, China,
| | - Yue Zhao
- Department of Gastroenterology, The First Hospital of Lanzhou University, Key Laboratory for Gastrointestinal Disease of Gansu Province, Lanzhou, China
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Stanneart J, Nunez KG, Sandow T, Gimenez J, Fort D, Hibino M, Cohen AJ, Thevenot PT. Imaging Delay Following Liver-Directed Therapy Increases Progression Risk in Early- to Intermediate-Stage Hepatocellular Carcinoma. Cancers (Basel) 2024; 16:212. [PMID: 38201639 PMCID: PMC10777927 DOI: 10.3390/cancers16010212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related deaths in the world. Patients with early-stage HCC are treated with liver-directed therapies to bridge or downstage for liver transplantation (LT). In this study, the impact of HCC care delay on HCC progression among early-stage patients was investigated. Early-stage HCC patients undergoing their first cycle of liver-directed therapy (LDT) for bridge/downstaging to LT between 04/2016 and 04/2022 were retrospectively analyzed. Baseline variables were analyzed for risk of disease progression and time to progression (TTP). HCC care delay was determined by the number of rescheduled appointments related to HCC care. The study cohort consisted of 316 patients who received first-cycle LDT. The HCC care no-show rate was associated with TTP (p = 0.004), while the overall no-show rate was not (p = 0.242). The HCC care no-show rate and HCC care delay were further expanded as no-show rates and rescheduled appointments for imaging, laboratory, and office visits, respectively. More than 60% of patients experienced HCC care delay for imaging and laboratory appointments compared to just 8% for office visits. Multivariate analysis revealed that HCC-specific no-show rates and HCC care delay for imaging (p < 0.001) were both independently associated with TTP, highlighting the importance of minimizing delays in early-stage HCC imaging surveillance to reduce disease progression risk.
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Affiliation(s)
- Jordin Stanneart
- University of Queensland Medical School, Brisbane, QLD 4072, Australia;
| | - Kelley G. Nunez
- Institute of Translational Research, Ochsner Health System, New Orleans, LA 70121, USA; (K.G.N.); (M.H.)
| | - Tyler Sandow
- Interventional Radiology, Ochsner Health System, New Orleans, LA 70121, USA; (T.S.); (J.G.)
| | - Juan Gimenez
- Interventional Radiology, Ochsner Health System, New Orleans, LA 70121, USA; (T.S.); (J.G.)
| | - Daniel Fort
- Center for Applied Health Services Research, Ochsner Health System, New Orleans, LA 70121, USA;
| | - Mina Hibino
- Institute of Translational Research, Ochsner Health System, New Orleans, LA 70121, USA; (K.G.N.); (M.H.)
| | - Ari J. Cohen
- Multi-Organ Transplant Institute, Ochsner Health System, New Orleans, LA 70121, USA;
- Faculty of Medicine, University of Queensland, Brisbane, QLD 4072, Australia
| | - Paul T. Thevenot
- Institute of Translational Research, Ochsner Health System, New Orleans, LA 70121, USA; (K.G.N.); (M.H.)
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Kudaravalli S, Kam LY, Huang DQ, Cheung R, Nguyen MH. Utilization of Antiviral Therapy for Patients With Hepatitis B-Related Hepatocellular Carcinoma: A Nationwide Real-World US Study. Clin Gastroenterol Hepatol 2023; 21:3305-3313.e4. [PMID: 37805836 DOI: 10.1016/j.cgh.2023.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/01/2023] [Accepted: 04/17/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND & AIMS Although oral antiviral therapy (OAV) is reported to improve outcomes in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), it is underutilized. We determined the rate and factors associated with OAV utilization among patients with HBV-related HCC in a US population with health insurance. METHODS Patients with HBV-related HCC were identified from the de-identified administrative health claims database for patients with private insurance, Optum Clinformatics (2003-2021). RESULTS We identified 2129 patients with HBV-related HCC: 71% male, mean age 62.7 ± 12.5 years, 40% Asian individuals, 72% with cirrhosis, and 37% received OAV. The treatment rate improved over time (40.5% after 2010 vs 26.3% earlier; P < .001). Significantly lower treatment rates were noted for females, non-Asian patients, noncirrhotic patients, and patients without gastroenterologist/hepatologist or infectious disease (GI/ID) specialist care (P < .0001). OAV treatment predictors included Asian race and ethnicity (adjusted odds ratio [aOR], 3.6; 95% CI, 2.8-4.5; P < .001), male sex (aOR, 1.6; 95% CI, 1.3-2.0; P < .001), seeing a GI/ID specialist (aOR, 1.5; 95% CI, 1.10-1.99; P = .0091), having compensated cirrhosis (aOR, 2.2; 95% CI, 1.7-2.8; P < .001), and being treated from 2011 to 2021 (aOR, 2.3; 95% CI, 1.8-3.0; P < .001); being younger (aOR, 0.98; 95% CI, 0.98-0.99; P < .001) was less likely for treatment. OAV initiated at or before HCC diagnosis was associated independently with improved survival (adjusted hazard ratio, 0.84; 95% CI, 0.72-0.99; P = .037). CONCLUSIONS Among patients with HBV-related HCC, only 1 in 3 received OAV despite having insurance coverage. Efforts must continue to develop ways to improve HBV OAV treatment, especially among females, non-Asian patients, and patients without cirrhosis or not seen by specialists.
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Affiliation(s)
- Sahith Kudaravalli
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Trinity College of Arts and Sciences, Duke University, Durham, North Carolina
| | - Leslie Y Kam
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California
| | - Daniel Q Huang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - Ramsey Cheung
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California; Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, California.
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Huang DC, Yu RL, Alqahtani S, Tamim H, Saberi B, Bonder A. Racial, ethnic, and socioeconomic disparities impact post-liver transplant survival in patients with hepatocellular carcinoma. Ann Hepatol 2023; 28:101127. [PMID: 37286167 DOI: 10.1016/j.aohep.2023.101127] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/16/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION AND OBJECTIVES Liver transplantation can be a curative treatment for patients with hepatocellular carcinoma (HCC); however, the morbidity and mortality associated with HCC varies by socioeconomic status and race and ethnicity. Policies like Share 35 were implemented to ensure equitable access to organ transplants; however, their impacts are unclear. We aimed to characterize differences in post-liver transplant (LT) survival among patients with HCC, when considering race and ethnicity, income, and insurance type, and understand if these associations were impacted by Share 35. MATERIALS AND METHODS We conducted a retrospective cohort study of 30,610 adult LT recipients with HCC. Data were obtained from the UNOS database. Survival analysis was carried out using Kaplan-Meier curves, and multivariate Cox regression analysis was used to calculate hazard ratios. RESULTS Men (HR: 0.90 (95% CI: 0.85-0.95)), private insurance (HR: 0.91 (95% CI: 0.87-0.92)), and income (HR: 0.87 (95% CI: 0.83-0.92)) corresponded with higher post-LT survival, when adjusted for over 20 demographic and clinical characteristics (Table 2). African American or Black individuals were associated with lower post-LT survival (HR: 1.20 (95% CI: 1.12-1.28)), whereas. Asian (HR: 0.79 (95% CI: 0.71-0.88)) or Hispanic (HR: 0.86 (95% CI: 0.81-0.92)) individuals were associated with higher survival as compared with White individuals (Table 2). Many of these patterns held in the pre-Share 35 and Share 35 periods. CONCLUSIONS Racial, ethnic, and socioeconomic disparities at time of transplant, such as private insurance and income, influence post-LT survival in patients with HCC. These patterns persist despite the passage of equitable access policies, such as Share 35.
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Affiliation(s)
- Dora C Huang
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Rosa L Yu
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Saleh Alqahtani
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, United States; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Hani Tamim
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Behnam Saberi
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alan Bonder
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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Ji J, Yang Y, Chen Z, Zhang W, Jiang S, Shen X, Zhang J, Lin L, Qu M, Wang Y, Gao X. How education level affects postoperative rehabilitation and follow-up: a single-center experience. BMC Urol 2023; 23:123. [PMID: 37464331 DOI: 10.1186/s12894-023-01282-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Radical prostatectomy remains the fundamental treatment for prostate cancer, and improving patients' compliance with postoperative follow-ups is essential for improving patients' quality of life. This study investigates the effect of education levels on patients' recovery and follow-up after radical prostatectomy. METHODS Data from 1,112 patients undergoing radical prostatectomy between 2011 and 2020 were collected using medical records, and "pc-follow" systems were used to collect patients' baseline information, education level, pathological information, number of outpatient visits, the time interval between each visit, and PSA test data. RESULTS Regarding postoperative outpatient data, there was no difference in the number of outpatient visits among the different education level groups in Shanghai (P = 0.063). A significant difference was found in the interval between outpatient visits among the groups (P < 0.001). Furthermore, significant differences were detected in the number and duration of outpatient clinic visits among the education level groups in all patients (P = 0.016, P = 0.0027). By contrast, no significant difference was found in the recovery time of urinary continence between all patients and those in Shanghai, grouped according to education level (P = 0.082, P = 0.68). For all patients and patients in the Shanghai area, the number of PSA follow-ups increased gradually with an increasing level of education (P < 0.001, P = 0.0029). CONCLUSIONS Education level affected the number of postoperative clinic visits, compliance, and the number of PSA tests. However, no significant effect on the recovery of urinary continence was found. Further, clinicians must increase their focus on patients with low education levels to achieve equitable access to health services for all patients.
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Affiliation(s)
- Jin Ji
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Yuchen Yang
- Nursing Department, Naval Hospital of Eastern Theater Command, PLA, Zhoushan, China
| | - Zeyu Chen
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Wenhui Zhang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Shaoqin Jiang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xianqi Shen
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Jili Zhang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Lu Lin
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Min Qu
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Yan Wang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China.
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Muacevic A, Adler JR. Investigating the Quality of Life for Cancer Patients and Estimating the Cost of Immunotherapy in Selected Cases. Cureus 2022; 14:e32390. [PMID: 36636546 PMCID: PMC9830274 DOI: 10.7759/cureus.32390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
The aim of this study is to assess the quality of life of patients receiving immune checkpoint inhibitors (ICI) by evaluating their physical and psychological well-being as well as their social and spiritual functioning. The 36-item Short Form Health Survey (SF-36) and quality of life core 30 (QLQ-C30) questionnaires were used to measure the quality of life of people receiving checkpoint inhibitors. An attempt was also made to make a rough estimate of the cost of checkpoint inhibitors in selected cases. The present study was conducted at the Oncology Day Hospital of the General University Hospital of Patras and the sample consisted of 100 subjects. The results of the two questionnaires show that the subjective evaluation of the patient's quality of life is satisfactory and functional since most of the respondents evaluate their quality of life as good to very good. Regarding the duration of immunotherapy, their health status seems to have improved, as 49% of respondents report having no pain, while the QLQ-C30 shows that 93% of patients have no problems with personal hygiene. Important determinants related to the limitation of work and daily activities were influenced by patients' age and marital status. Finally, age, monthly income, and education level seem to exert a general influence on a person's physical condition.
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Deng X, Yang X, Yang C, Chen K, Ren J, Zeng J, Zhang Q, Li T, Tang Q, Zhu J. Socioeconomic deprivation and survival outcomes in primary central nervous system lymphomas. Front Oncol 2022; 12:929585. [PMID: 36091170 PMCID: PMC9459230 DOI: 10.3389/fonc.2022.929585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/05/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To our knowledge, the impact of area-level socioeconomic status (SES) has not yet been described in primary central nervous system lymphomas (PCNSLs). Current study sought to explore the association of socioeconomic deprivation, measured using the Area Deprivation Index (ADI), with PCNSL outcomes. Methods The Surveillance, Epidemiology, and End Results (SEER) database was used to identify PCNSL patients diagnosed between 2006 and 2015 for our analyses. The impact of ADI on overall survival (OS) and cancer-specific survival (CSS) were investigated. Survival analyses were conducted using Kaplan-Meier method with log-rank tests. The Inverse Probability Weighting (IPW) analysis and multivariate cox proportional hazards regression analysis were employed to make covariate adjustments. Multiple mediation analysis (MMA) was performed to estimate the mediating effects. Results A total of 3159 PCNSL patients classified into low and high ADI subgroups according to the median ADI score were studied. The Kaplan-Meier analyses showed that low ADI was significantly associated with higher OS rates (HR 1.15, 95%CI 1.06-1.26, P<0.01) and CSS rates (HR 1.15, 95%CI 1.05-1.27, P<0.01). Similar results were observed in analyses adjusted via IPW and multivariate cox methods. Subgroup analyses revealed that ADI could remain a prognostic indictor among different subsets. MMA revealed that several factors including chemotherapy and HIV status making up about 40% of the overall effect, mediated PCNSL survival disparities related to the ADI. Finally, multivariable logistic regression analysis showed that ADI as well as several other factors were independently related to receipt of chemotherapy. Conclusions Our study highlights the role of area-level SES in prognosis of PCNSLs. And several factors including chemotherapy and HIV status of PCNSL patents contributed to the CSS disparities between ADI subgroups were uncovered by MMA. Such relationships would highlight the importance of policies development to enhance healthcare delivery and promote awareness of HIV prevention and treatment in low-resource neighborhoods.
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Affiliation(s)
- Xiangyang Deng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Lab. for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Lab. of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai, China
| | - Xionggang Yang
- Department of Orthopaedics Surgery, Fudan University Huashan Hospital, Shanghai, China
| | - Chunlei Yang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Lab. for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Lab. of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai, China
| | - Kezhu Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Lab. for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Lab. of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai, China
| | - Junwei Ren
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Lab. for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Lab. of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai, China
| | - Jun Zeng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Lab. for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Lab. of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai, China
| | - Quan Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Lab. for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Lab. of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai, China
| | - Tianwen Li
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Lab. for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Lab. of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai, China
| | - Qisheng Tang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Lab. for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Lab. of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai, China
| | - Jianhong Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, National Center for Neurological Disorders, National Key Lab. for Medical Neurobiology, Institutes of Brain Science, Shanghai Key Lab. of Brain Function and Regeneration, Institute of Neurosurgery, MOE Frontiers Center for Brain Science, Shanghai, China
- *Correspondence: Jianhong Zhu,
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Alvarez GM, Rudolph MD, Cohen JR, Muscatell KA. Lower Socioeconomic Position Is Associated with Greater Activity in and Integration within an Allostatic-Interoceptive Brain Network in Response to Affective Stimuli. J Cogn Neurosci 2022; 34:1906-1927. [PMID: 35139207 DOI: 10.1162/jocn_a_01830] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Socioeconomic inequities shape physical health and emotional well-being. As such, recent work has examined the neural mechanisms through which socioeconomic position (SEP) may influence health. However, there remain critical gaps in knowledge regarding the relationships between SEP and brain function. These gaps include a lack of research on: (1) the association between SEP and brain functioning in later life, (2) relationships between SEP and functioning of the whole brain beyond specific regions of interest, and (3) how neural responses to positive affective stimuli differ by SEP. The current study addressed these gaps by examining the association between SEP (i.e., education, income) and neural responses to affective stimuli among 122 mid- to late-life adults. During MRI scanning, participants viewed 30 positive, 30 negative, and 30 neutral images; activation and network connectivity analyses explored associations between SEP and neural responses to these affective stimuli. Analyses revealed that those with lower SEP showed greater neural activity to both positive and negative images in regions within the allostatic-interoceptive network, a system of regions implicated in representing and regulating physiological states of the body and the external environment. There were no positive associations between SEP and neural responses to negative or positive images. In addition, graph-theory network analyses showed that individuals with lower SEP demonstrated greater global efficiency within the allostatic-interoceptive network and executive control network, across all task conditions. The findings suggest that lower SEP is associated with enhanced neural sensitivity to affective cues that may be metabolically costly to maintain over time and suggest a mechanism by which SEP might get "under the skull" to influence mental and physical well-being.
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Affiliation(s)
| | | | - Jessica R Cohen
- University of North Carolina at Chapel Hill.,Carolina Institute for Developmental Disabilities, Carrboro, NC
| | - Keely A Muscatell
- University of North Carolina at Chapel Hill.,Carolina Institute for Developmental Disabilities, Carrboro, NC
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Zheng Y, Zhang X, Lu J, Liu S, Qian Y. Association between socioeconomic status and survival in patients with hepatocellular carcinoma. Cancer Med 2021; 10:7347-7359. [PMID: 34414679 PMCID: PMC8525159 DOI: 10.1002/cam4.4223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/02/2021] [Accepted: 08/08/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The effect of socioeconomic status (SES) on hepatocellular carcinoma (HCC) is still unclear, and there is no nomogram integrated SES and clinicopathological factors to predict the prognosis of HCC. This research aims to confirm the effects of SES on predicting patients' survival and to establish a nomogram to predict the prognosis of HCC. METHODS The data of HCC patients were collected from the Surveillance, Epidemiology, and Final Results (SEER) database from 2011 to 2015. SES (age at diagnosis, race and sex, median family income, education level, insurance status, marital status, residence, cost of living index, poverty rate) and clinicopathological factors were included in univariate and multivariate Cox regression analysis. Nomograms for predicting 1-, 3-, and 5-year cancer-specific survival (CSS) and overall survival (OS) were established and evaluated by the concordance index (C-index), the receiver operating characteristic curve (ROC), the calibration plot, the integrated discrimination improvement (IDI), and the net reclassification improvement (NRI). RESULTS A total of 33,670 diagnosed HCC patients were involved, and nomograms consisting of 19 variables were established. The C-indexes of the nomograms are higher than TNM staging system, which predicts the CSS (0.789 vs. 0.692, p < 0.01) and OS (0.777 vs. 0.675, p < 0.01). The ROC curve, calibration diagram, IDI, and NRI showed the improved prognostic value in 1-, 3-, and 5-year survival rates. CONCLUSION SES plays an important role in the prognosis of HCC patients. Therefore, policymakers can make more precise and socially approved policies to improve HCC patients' CSS and OS.
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Affiliation(s)
- Yongshun Zheng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xun Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jinsen Lu
- Department of Orthopedics, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Shuchen Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yeben Qian
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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