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Walls GM, Mitchell JD, Lyon AR, Harbinson M, Hanna GG. Radiation Oncology Opinions and Practice on Cardiotoxicity in Lung Cancer: A Cross-sectional Study by the International Cardio-oncology Society. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00379-0. [PMID: 39317606 DOI: 10.1016/j.clon.2024.09.001] [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: 02/21/2024] [Revised: 07/31/2024] [Accepted: 09/02/2024] [Indexed: 09/26/2024]
Abstract
AIMS Symptomatic radiation cardiotoxicity affects up to 30% patients with lung cancer and several heart substructure doses are associated with reduced overall survival. A greater focus on minimising cardiotoxicity is now possible due to advancements in radiotherapy technology and the new discipline of cardio-oncology, but uptake of emerging data has not been ascertained. A global cross-sectional analysis of Radiation Oncologists who treat lung cancer was therefore conducted by the International Cardio-Oncology Society in order to establish the impact of recently published literature and guidelines on practice. MATERIALS AND METHODS A bespoke questionnaire was designed following an extensive review of the literature and from recurring relevant themes presented at Radiation Oncology and Cardio-Oncology research meetings. Six question domains were retained following consensus discussions among the investigators, comprising 55 multiple choice stems: guidelines, cardiovascular assessment, cardiology investigations, radiotherapy planning strategies, primary prevention prescribing and local cardio-oncology service access. An invitation was sent to all Radiation Oncologists registered with ICOS and to Radiation Oncology colleagues of the investigators. RESULTS In total 118 participants were recruited and 92% were consultant physicians. The ICOS 2021 expert consensus statement was rated as the most useful position paper, followed by the joint ESC-ESTRO 2022 guideline. The majority (80%) of participants indicated that a detailed cardiovascular history was advisable. Although 69% of respondents deemed the availability of cardiac substructure auto-segmentation to be very/quite important, it was implemented by only a few, with the most common being the left anterior descending coronary artery V15. A distinct cardio-oncology service was available to 39% participants, while the remainder utilised general cardiology services. CONCLUSION The uptake of recent guidelines on cardiovascular optimisation is good, but access to cardiology investigations and consultations, and auto-segmentation, represent barriers to modifying radiotherapy practices in lung cancer to reduce the risk of radiation cardiotoxicity.
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Affiliation(s)
- G M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Ireland.
| | - J D Mitchell
- Cardio-Oncology Center of Excellence, Washington University in St Louis, St Louis, Missouri, USA
| | - A R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, London, UK
| | - M Harbinson
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Ireland; Wellcome-Wolfson Centre for Experimental Medicine, Queen's University Belfast, Jubilee Road, Belfast, Ireland
| | - G G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Ireland; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Ireland
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2
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Strömberg U, Berglund A, Carlsson S, Thellenberg Karlsson C, Lambe M, Lissbrant IF, Stattin P, Bratt O. Socioeconomic inequality in prostate cancer diagnostics, primary treatment, rehabilitation, and mortality in Sweden. Int J Cancer 2024; 155:637-645. [PMID: 38526118 DOI: 10.1002/ijc.34932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024]
Abstract
We designed a nationwide study to investigate the association between socioeconomic factors (household income and education) and different aspects of prostate cancer care, considering both individual- and neighbourhood-level variables. Data were obtained from Prostate Cancer data Base Sweden (PCBaSe), a research database with data from several national health care registers including clinical characteristics and treatments for nearly all men diagnosed with prostate cancer in Sweden. Four outcomes were analysed: use of pre-biopsy magnetic resonance imaging (MRI) in 2018-2020 (n = 11,843), primary treatment of high-risk non-metastatic disease in 2016-2020 (n = 6633), rehabilitation (≥2 dispensed prescriptions for erectile dysfunction within 1 year from surgery in 2016-2020, n = 6505), and prostate cancer death in 7770 men with high-risk non-metastatic disease diagnosed in 2010-2016. Unadjusted and adjusted odds and hazard ratios (OR/HRs) with 95% confidence intervals (CIs) were calculated. Adjusted odds ratio (ORs) comparing low versus high individual education were 0.74 (95% CI 0.66-0.83) for pre-biopsy MRI, 0.66 (0.54-0.81) for primary treatment, and 0.82 (0.69-0.97) for rehabilitation. HR gradients for prostate cancer death were significant on unadjusted analysis only (low vs. high individual education HR 1.41, 95% CI 1.17-1.70); co-variate adjustments markedly attenuated the gradients (low vs. high individual education HR 1.10, 95% CI 0.90-1.35). Generally, neighbourhood-level analyses showed weaker gradients over the socioeconomic strata, except for pre-biopsy MRI. Socioeconomic factors influenced how men were diagnosed with prostate cancer in Sweden but had less influence on subsequent specialist care. Neighbourhood-level socioeconomic data are more useful for evaluating inequality in diagnostics than in later specialist care.
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Affiliation(s)
- Ulf Strömberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | | | - Stefan Carlsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Urology, Karolinska University Hospital Solna, Stockholm, Sweden
| | | | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Ingela Franck Lissbrant
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Ola Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
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3
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Kennedy K, Jusue-Torres I, Buller ID, Rossi E, Mallisetty A, Rodgers K, Lee B, Menchaca M, Pasquinelli M, Nguyen RH, Weinberg F, Rubinstein I, Herman JG, Brock M, Feldman L, Aldrich MC, Hulbert A. Neighborhood-level deprivation and survival in lung cancer. BMC Cancer 2024; 24:959. [PMID: 39107707 PMCID: PMC11301857 DOI: 10.1186/s12885-024-12720-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Despite recent advances in lung cancer therapeutics and improving overall survival, disparities persist among socially disadvantaged populations. This study aims to determine the effects of neighborhood deprivation indices (NDI) on lung cancer mortality. This is a multicenter retrospective cohort study assessing the relationship between NDI and overall survival adjusted for age, disease stage, and DNA methylation among biopsy-proven lung cancer patients. State-specific NDI for each year of sample collection were computed at the U.S. census tract level and dichotomized into low- and high-deprivation. RESULTS A total of 173 non small lung cancer patients were included, with n = 85 (49%) and n = 88 (51%) in the low and high-deprivation groups, respectively. NDI was significantly higher among Black patients when compared with White patients (p = 0.003). There was a significant correlation between DNA methylation and stage for HOXA7, SOX17, ZFP42, HOXA9, CDO1 and TAC1. Only HOXA7 DNA methylation was positively correlated with NDI. The high-deprivation group had a statistically significant shorter survival than the low-deprivation group (p = 0.02). After adjusting for age, race, stage, and DNA methylation status, belonging to the high-deprivation group was associated with higher mortality with a hazard ratio of 1.81 (95%CI: 1.03-3.19). CONCLUSIONS Increased neighborhood-level deprivation may be associated with liquid biopsy DNA methylation, shorter survival, and increased mortality. Changes in health care policies that consider neighborhood-level indices of socioeconomic deprivation may enable a more equitable increase in lung cancer survival.
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Affiliation(s)
- Kathleen Kennedy
- Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Ignacio Jusue-Torres
- Department of Neurologic Surgery, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Ian D Buller
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Emily Rossi
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Apurva Mallisetty
- Department of Surgery, Cancer Center, University of Illinois College of Medicine in Chicago, 909 South Wolcott Ave COMRB Suite 5140, Chicago, IL, 60612, USA
| | - Kristen Rodgers
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Beverly Lee
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Martha Menchaca
- Department of Radiology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Mary Pasquinelli
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Ryan H Nguyen
- Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Frank Weinberg
- Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
| | - Israel Rubinstein
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
- Division of Research Services, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - James G Herman
- Lung Cancer Program, University of Pittsburgh Cancer Institute, The Hillman Cancer Center, Pittsburgh, PA, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Malcolm Brock
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - Lawrence Feldman
- Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA
- Division of Research Services, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Melinda C Aldrich
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alicia Hulbert
- Department of Surgery, Cancer Center, University of Illinois College of Medicine in Chicago, 909 South Wolcott Ave COMRB Suite 5140, Chicago, IL, 60612, USA.
- Division of Research Services, Jesse Brown VA Medical Center, Chicago, IL, USA.
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.
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4
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Tollosa DN, Zendehdel K, Procopio A, Cederström A, Boffetta P, Pukkala E, Rostila M. Cancer mortality by country of birth and cancer type in Sweden: A 25-year registry-based cohort study. Cancer Med 2024; 13:e70020. [PMID: 39016445 PMCID: PMC11253184 DOI: 10.1002/cam4.70020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/12/2024] [Accepted: 07/05/2024] [Indexed: 07/18/2024] Open
Abstract
Numerous studies have reported lower overall cancer mortality rates among immigrants compared to native populations. However, limited information exists regarding cancer mortality among immigrants based on specific birth countries and cancer types. We used population-based registries and followed 10 million individuals aged 20 years or older in Sweden between 1992 and 2016. The Cox proportional hazard model was used to explore the disparities in cancer mortality by country of birth and cancer type, stratified by gender. Age-standardized mortality rates were also computed using the world standard population. Hazard ratio (HR) of all-site cancer was slightly lower among immigrants (males: HRm = 0.97: 95% confidence interval: 0.95, 0.98; females: HRf = 0.93: 0.91, 0.94) than Swedish-born population. However, the immigrants showed higher mortality for infection-related cancers, including liver (HRf = 1.10: 1.01, 1.19; HRm = 1.10: 1.02, 1.17), stomach (HRf = 1.39: 1.31, 1.49; HRm = 1.33: 1.26, 1.41) cancers, and tobacco-related cancers, including lung (HRm = 1.44: 1.40, 1.49), and laryngeal cancers (HRm = 1.47: 1.24, 1.75). The HR of mesothelioma was also significantly higher in immigrants (HRf = 1.44: 1.10, 1.90). Mortality from lung cancer was specifically higher in men from Nordic (HRm = 1.41: 1.27, 1.55) and non-Nordic Europe (HRm = 1.49: 1.43, 1.55) countries and lower in Asian (HRm = 0.78: 0.66, 0.93) and South American men (HRm = 0.70: 0.57, 0.87). In conclusion, there are large variations in cancer mortality by country of birth, and cancer type and require regular surveillance. Our detailed analyses lead to some novel findings such as excess mortality rate of mesothelioma and laryngeal cancers in Immigrants in Sweden. A targeted cancer prevention program among immigrants in Sweden is needed.
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Affiliation(s)
| | - Kazem Zendehdel
- Cancer Research Center, Cancer InstituteTehran University of Medical SciencesTehranIran
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | | | - Agneta Cederström
- Department of Public Health SciencesStockholm UniversityStockholmSweden
| | - Paolo Boffetta
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
- Stony Brook Cancer CenterStony Brook UniversityStony BrookNew YorkUSA
| | - Eero Pukkala
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland
- Health Sciences Unit, Faculty of Social SciencesTampere UniversityTampereFinland
| | - Mikael Rostila
- Department of Public Health SciencesStockholm UniversityStockholmSweden
- Centre for Health Equity Studies (CHESS)Stockholm University/Karolinska InstitutetStockholmSweden
- Aging Research Center (ARC)Karolinska InstitutetSolnaSweden
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5
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Rosamilia MB, Williams J, Bair CA, Mulder H, Chiswell KE, D'Ottavio AA, Hartman RJ, Sang CJ, Welke KF, Walsh MJ, Hoffman TM, Landstrom AP, Li JS, Sarno LA. Risk Factors and Outcomes Associated with Gaps in Care in Children with Congenital Heart Disease. Pediatr Cardiol 2024; 45:976-985. [PMID: 38485760 PMCID: PMC11056317 DOI: 10.1007/s00246-024-03414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/09/2024] [Indexed: 04/29/2024]
Abstract
Adults with congenital heart disease (CHD) benefit from cardiology follow-up at recommended intervals of ≤ 2 years. However, benefit for children is less clear given limited studies and unclear current guidelines. We hypothesize there are identifiable risks for gaps in cardiology follow-up in children with CHD and that gaps in follow-up are associated with differences in healthcare utilization. Our cohort included children < 10 years old with CHD and a healthcare encounter from 2008 to 2013 at one of four North Carolina (NC) hospitals. We assessed associations between cardiology follow-up and demographics, lesion severity, healthcare access, and educational isolation (EI). We compared healthcare utilization based on follow-up. Overall, 60.4% of 6,969 children received cardiology follow-up within 2 years of initial encounter, including 53.1%, 58.1%, and 79.0% of those with valve, shunt, and severe lesions, respectively. Factors associated with gaps in care included increased drive time to a cardiology clinic (Hazard Ratio (HR) 0.92/15-min increase), EI (HR 0.94/0.2-unit increase), lesion severity (HR 0.48 for shunt/valve vs severe), and older age (HR 0.95/month if < 1 year old and 0.94/year if > 1 year old; p < 0.05). Children with a care gap subsequently had more emergency department (ED) visits (Rate Ratio (RR) 1.59) and fewer inpatient encounters and procedures (RR 0.51, 0.35; p < 0.05). We found novel factors associated with gaps in care for cardiology follow-up in children with CHD and altered health care utilization with a gap. Our findings demonstrate a need to mitigate healthcare barriers and generate clear cardiology follow-up guidelines for children with CHD.
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Affiliation(s)
| | - Jason Williams
- Department of Pediatrics, Division of Pediatric Cardiology, Duke School of Medicine, Durham, NC, USA
| | | | - Hillary Mulder
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Karen E Chiswell
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Alfred A D'Ottavio
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Robert J Hartman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, NC, USA
| | - Charlie J Sang
- Department of Pediatrics, Division of Pediatric Cardiology, East Carolina University, Greenville, NC, USA
| | - Karl F Welke
- Department of Surgery, Division of Pediatric Cardiothoracic Surgery, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Michael J Walsh
- Department of Pediatrics, Division of Pediatric Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Timothy M Hoffman
- Department of Pediatrics, Division of Pediatric Cardiology, University of North Carolina at Chapel Hill Medical Center, Chapel Hill, NC, USA
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Pediatric Cardiology, Duke School of Medicine, Durham, NC, USA
- Department of Cell Biology, Duke School of Medicine, Durham, NC, USA
| | - Jennifer S Li
- Department of Pediatrics, Division of Pediatric Cardiology, Duke School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Lauren A Sarno
- Department of Pediatrics, Division of Pediatric Cardiology, East Carolina University, Greenville, NC, USA.
- Brody School of Medicine, East Carolina University, 115 Heart Drive, Greenville, NC, 27834, USA.
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6
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Qiu LH, Song JQ, Jiang F, Zhao YY, Liu Y, Wu LL, Ma GW. Marital status impacts survival of stage I non-small-cell lung cancer: a propensity-score matching analysis. Future Sci OA 2024; 10:FSO926. [PMID: 38827800 PMCID: PMC11140661 DOI: 10.2144/fsoa-2023-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/25/2023] [Indexed: 06/05/2024] Open
Abstract
Aim: This population-based analysis aimed to explore the associations among marital status, prognosis and treatment of stage I non-small-cell lung cancer. Materials & methods: The propensity score matching (PSM), logistic regression and Cox proportional hazards model were used in this study. Results: A total of 13,937 patients were included. After PSM, 10579 patients were co-insured. The married were more likely to receive surgical treatment compared with the unmarried patients (OR: 1.841, p < 0.001), and patients who underwent surgery also tended to have better survival (HR: 0.293, p < 0.001). Conclusion: Compared with unmarried patients, a married group with stage I NSCLC had timely treatment and more satisfactory survival. This study highlights the importance of prompt help and care for unmarried patients.
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Affiliation(s)
- Li-Hong Qiu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510000, PR China
| | - Jia-Qi Song
- School of Medicine, Tongji University, Shanghai, 200092, PR China
| | - Feng Jiang
- Department of Oncology, Zhongda Hospital, Southeast University, Nanjing, 210009, PR China
| | - Yuan-Yuan Zhao
- School of Medicine, Tongji University, Shanghai, 200092, PR China
| | - Yu'e Liu
- School of Medicine, Tongji University, Shanghai, 200092, PR China
| | - Lei-Lei Wu
- School of Medicine, Tongji University, Shanghai, 200092, PR China
| | - Guo-Wei Ma
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510000, PR China
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7
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Lam S, Bai C, Baldwin DR, Chen Y, Connolly C, de Koning H, Heuvelmans MA, Hu P, Kazerooni EA, Lancaster HL, Langs G, McWilliams A, Osarogiagbon RU, Oudkerk M, Peters M, Robbins HA, Sahar L, Smith RA, Triphuridet N, Field J. Current and Future Perspectives on Computed Tomography Screening for Lung Cancer: A Roadmap From 2023 to 2027 From the International Association for the Study of Lung Cancer. J Thorac Oncol 2024; 19:36-51. [PMID: 37487906 PMCID: PMC11253723 DOI: 10.1016/j.jtho.2023.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
Low-dose computed tomography (LDCT) screening for lung cancer substantially reduces mortality from lung cancer, as revealed in randomized controlled trials and meta-analyses. This review is based on the ninth CT screening symposium of the International Association for the Study of Lung Cancer, which focuses on the major themes pertinent to the successful global implementation of LDCT screening and develops a strategy to further the implementation of lung cancer screening globally. These recommendations provide a 5-year roadmap to advance the implementation of LDCT screening globally, including the following: (1) establish universal screening program quality indicators; (2) establish evidence-based criteria to identify individuals who have never smoked but are at high-risk of developing lung cancer; (3) develop recommendations for incidentally detected lung nodule tracking and management protocols to complement programmatic lung cancer screening; (4) Integrate artificial intelligence and biomarkers to increase the prediction of malignancy in suspicious CT screen-detected lesions; and (5) standardize high-quality performance artificial intelligence protocols that lead to substantial reductions in costs, resource utilization and radiologist reporting time; (6) personalize CT screening intervals on the basis of an individual's lung cancer risk; (7) develop evidence to support clinical management and cost-effectiveness of other identified abnormalities on a lung cancer screening CT; (8) develop publicly accessible, easy-to-use geospatial tools to plan and monitor equitable access to screening services; and (9) establish a global shared education resource for lung cancer screening CT to ensure high-quality reading and reporting.
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Affiliation(s)
- Stephen Lam
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Chunxue Bai
- Shanghai Respiratory Research Institute and Chinese Alliance Against Cancer, Shanghai, People's Republic of China
| | - David R Baldwin
- Nottingham University Hospitals National Health Services (NHS) Trust, Nottingham, United Kingdom
| | - Yan Chen
- Digital Screening, Faculty of Medicine & Health Sciences, University of Nottingham Medical School, Nottingham, United Kingdom
| | - Casey Connolly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Harry de Koning
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, The Netherlands
| | - Marjolein A Heuvelmans
- University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands; The Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Ping Hu
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ella A Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Harriet L Lancaster
- University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands; The Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Georg Langs
- Computational Imaging Research Laboratory, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Australia University of Western Australia, Nedlands, Western Australia
| | | | - Matthijs Oudkerk
- Center for Medical Imaging and The Institute for Diagnostic Accuracy, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Matthew Peters
- Woolcock Institute of Respiratory Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Liora Sahar
- Data Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia
| | | | - John Field
- Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, United Kingdom
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8
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Robinson-Oghogho JN, Alcaraz KI, Thorpe RJ. Structural Racism as a Contributor to Lung Cancer Incidence and Mortality Rates Among Black Populations in the United States. Cancer Control 2024; 31:10732748241248363. [PMID: 38698674 PMCID: PMC11067682 DOI: 10.1177/10732748241248363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Although racial disparities in lung cancer incidence and mortality have diminished in recent years, lung cancer remains the second most diagnosed cancer among US Black populations. Many factors contributing to disparities in lung cancer are rooted in structural racism. To quantify this relationship, we examined associations between a multidimensional measure of county-level structural racism and county lung cancer incidence and mortality rates among Black populations, while accounting for county levels of environmental quality. METHODS We merged 2016-2020 data from the United States Cancer Statistics Data Visualization Tool, a pre-existing county-level structural racism index, the Environmental Protection Agency's 2006-2010 Environmental Quality Index (EQI), 2023 County Health Rankings, and the 2021 United States Census American Community Survey. We conducted multivariable linear regressions to examine associations between county-level structural racism and county-level lung cancer incidence and mortality rates. RESULTS Among Black males and females, each standard deviation increase in county-level structural racism score was associated with an increase in county-level lung cancer incidence of 6.4 (95% CI: 4.4, 8.5) cases per 100,000 and an increase of 3.3 (95% CI: 2.0, 4.6) lung cancer deaths per 100,000. When examining these associations stratified by sex, larger associations between structural racism and lung cancer rates were observed among Black male populations than among Black females. CONCLUSION Structural racism contributes to both the number of new lung cancer cases and the number of deaths caused by lung cancer among Black populations. Those aiming to reduce lung cancer cases and deaths should consider addressing racism as a root-cause.
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Affiliation(s)
- Joelle N. Robinson-Oghogho
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kassandra I. Alcaraz
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Roland J. Thorpe
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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9
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Jansåker F, Sundquist J, Sundquist K, Li X. Association between neighborhood deprivation and mortality in patients with schizophrenia and bipolar disorder-A nationwide follow-up study. Bipolar Disord 2023; 25:489-498. [PMID: 36751995 DOI: 10.1111/bdi.13309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES The aim was to explore the association between neighborhood deprivation and all-cause mortality and cause-specific mortalities in patients with schizophrenia and bipolar disorder. A better understanding of this potential relationship may help to identify patients with schizophrenia and bipolar disorder with an increased mortality risk. METHODS This nationwide study included practically all adults (≥30 years) diagnosed with schizophrenia (n = 34,544) and bipolar disorder (n = 64,035) in Sweden (1997-2017). The association between neighborhood deprivation and mortality was explored using Cox regression. All models were conducted in both men and women and adjusted for individual-level sociodemographic factors and comorbidities. RESULTS There was an association between level of neighborhood deprivation and all-cause mortality in both groups. The adjusted hazard ratios for all-cause mortality associated with high compared to low neighborhood deprivation were 1.18 (95% confidence interval 1.11-1.25) in patients with schizophrenia and 1.33 (1.26-1.41) in patients with bipolar disorder. The two most common mortality causes in both groups were coronary heart disease and cancer. The mortality due to coronary heart disease increased when neighborhood deprivation increased and reached 1.37 (1.18-1.60) in patients with schizophrenia and 1.70 (1.44-2.01) in patients with bipolar disorder living in the most deprived neighborhoods. CONCLUSIONS This study shows that neighborhood deprivation is an important risk factor for all-cause mortality and most cause-specific mortalities among patients with schizophrenia and bipolar disorder. These findings could serve as aid to policymakers when allocating healthcare resources and to clinicians who encounter patients with these conditions in deprived neighborhoods.
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Affiliation(s)
- Filip Jansåker
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Center of Diagnostic Investigations, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Lund, Sweden
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Walls GM, O'Connor J, Harbinson M, McCarron EP, Duane F, McCann C, McKavanagh P, Johnston DI, Erekkath J, Giacometti V, Gavin AT, McAleese J, Hounsell AR, Cole AJ, Butterworth KT, McGarry CK, Hanna GG, Jain S. Association between statin therapy dose intensity and radiation cardiotoxicity in non-small cell lung cancer: Results from the NI-HEART study. Radiother Oncol 2023; 186:109762. [PMID: 37348608 DOI: 10.1016/j.radonc.2023.109762] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Radiation cardiotoxicity is a dose-limiting toxicity and major survivorship issue for patients with non-small cell lung cancer (NSCLC) completing curative-intent radiotherapy, however patients' cardiovascular baseline is not routinely optimised prior to treatment. In this study we examined the impact of statin therapy on overall survival and post-radiotherapy cardiac events. METHODS Patients treated between 2015-2020 at a regional center were identified. Clinical notes were interrogated for baseline patient, tumor and cardiac details, and both follow-up cancer control and cardiac events. Three cardiologists verified cardiac events. Radiotherapy planning scans were retrieved for application of validated deep learning-based autosegmentation. Pre-specified Cox regression analyses were generated with varying degrees of adjustment for overall survival. Fine and Gray regression for the risk of cardiac events, accounting for the competing risk of death and cardiac covariables was undertaken. RESULTS Statin therapy was prescribed to 59% of the 478 included patients. The majority (88%) of patients not prescribed a statin had at least one indication for statin therapy according to cardiovascular guidelines. In total, 340 patients (71%) died and 79 patients (17%) experienced a cardiac event. High-intensity (HR 0.68, 95%CI 0.50-0.91, p = 0.012) and medium-intensity (HR 0.70, 95%CI 0.51-0.97, p = 0.033) statin therapy were associated with improved overall survival after adjustment for patient, cancer, treatment, response and cardiovascular clinical factors. There were no consistent differences in the rate or grade of cardiac events according to statin intensity. CONCLUSIONS Statin therapy is associated with improved overall survival in patients receiving curative-intent radiotherapy for NSCLC, and there is evidence of a dose-response relationship. This study highlights the importance of a pre-treatment cardiovascular risk assessment in this cohort. Further studies are needed to examine if statin therapy is cardioprotective in patients undergoing treatment for NSCLC with considerable incidental cardiac radiation dose and a low baseline cardiac risk.
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Affiliation(s)
- Gerard M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom.
| | - John O'Connor
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Mark Harbinson
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Eamon P McCarron
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom; Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast Health and Social Care Trust, Falls Road, Belfast, Northern Ireland, United Kingdom
| | - Frances Duane
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland
| | - Conor McCann
- Department of Cardiology, Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Peter McKavanagh
- Department of Cardiology, Ulster Hospital, South Eastern Health & Social Care Trust, Upper Newtonards Road, Dundonald, Northern Ireland, United Kingdom
| | - David I Johnston
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Jayaraj Erekkath
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Valentina Giacometti
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Anna T Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Falls Road, Belfast, Northern Ireland, United Kingdom
| | - Jonathan McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Alan R Hounsell
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Aidan J Cole
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom
| | - Karl T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Conor K McGarry
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Gerard G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
| | - Suneil Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Lisburn Road, Belfast, Northern Ireland, United Kingdom; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Jubilee Road, Belfast, Northern Ireland, United Kingdom
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11
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Katayama O, Lee S, Bae S, Makino K, Chiba I, Harada K, Shinkai Y, Shimada H. Differential effects of lifestyle activities on disability incidence based on neighborhood amenities. BMC Geriatr 2023; 23:483. [PMID: 37563564 PMCID: PMC10416387 DOI: 10.1186/s12877-023-04170-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 07/13/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND This study examined the effect of neighborhood amenities on disability risk among community-dwelling older adults in Japan, based on lifestyle activities. METHOD This was an observational prospective cohort study. Participants comprised 13,258 older adults from the National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes. We calculated participants' Walk Score using their home addresses and divided them into three groups: "car-dependent," "somewhat walkable," and "very walkable." We then calculated the average value of lifestyle activities. We divided the neighborhood amenity groups into two groups, "fewer lifestyle activities" and "more lifestyle activities," for a total of six groups. After identifying interactions between neighborhood amenities and lifestyle activities, Cox proportional hazard models to calculate hazard ratios for incident disability risk, based on neighborhood amenities and lifestyle activities. RESULTS An interaction occurred between neighborhood amenities and lifestyle activities (p < 0.05). Survival probabilities for incident disability based on lifestyle activities were estimated for each neighborhood amenity group: car-dependent, 1.62 (95% CI 1.07 to 2.46); somewhat walkable, 1.08 (95% CI 0.84 to 1.40); and very walkable, 1.05 (95% CI 0.87 to 1.27). Those with fewer lifestyle activities in the car-dependent group exhibited the highest risk of incident disability in the unadjusted and adjusted models. CONCLUSION Given that the aging population is increasing steadily, considering older adults' neighborhood amenities and lifestyle activities in their day-to-day lives can help clinicians to deliver more older adult-centered care. Incorporating the lifestyle activities and neighborhood amenities of older adults into care planning will lead to the design and development of integrated clinical and community screening programs.
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Affiliation(s)
- Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan.
- Japan Society for the Promotion of Science, Tokyo, Japan.
- Columbia University Irving Medical Center, New York, USA.
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| | - Seongryu Bae
- Department of Health Care and Science, Dong-A University, Busan, Korea
| | - Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Ippei Chiba
- Tohoku Medical Megabank Organization (ToMMo), Tohoku University, Sendai, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| | - Yohei Shinkai
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu City, 474-8511, Aichi, Japan
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12
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Redondo-Sánchez D, Fernández-Navarro P, Rodríguez-Barranco M, Nuñez O, Petrova D, García-Torrecillas JM, Jiménez-Moleón JJ, Sánchez MJ. Socio-economic inequalities in lung cancer mortality in Spain: a nation-wide study using area-based deprivation. Int J Equity Health 2023; 22:145. [PMID: 37533035 PMCID: PMC10399030 DOI: 10.1186/s12939-023-01970-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/19/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Lung cancer is the main cause of cancer mortality worldwide and in Spain. Several previous studies have documented socio-economic inequalities in lung cancer mortality but these have focused on specific provinces or cities. The goal of this study was to describe lung cancer mortality in Spain by sex as a function of socio-economic deprivation. METHODS We analysed all registered deaths from lung cancer during the period 2011-2017 in Spain. Mortality data was obtained from the National Institute of Statistics, and socio-economic level was measured with the small-area deprivation index developed by the Spanish Society of Epidemiology, with the census tract of residence at the time of death as the unit of analysis. We computed crude and age-standardized rates per 100,000 inhabitants by sex, deprivation quintile, and type of municipality (rural, semi-rural, urban) considering the 2013 European standard population (ASR-E). We further calculated ASR-E ratios between the most deprived (Q5) and the least deprived (Q1) areas and mapped census tract smoothed standardized lung cancer mortality ratios by sex. RESULTS We observed 148,425 lung cancer deaths (80.7% in men), with 73.5 deaths per 100,000 men and 17.1 deaths per 100,000 women. Deaths from lung cancer in men were five times more frequent than in women (ASR-E ratio = 5.3). Women residing in the least deprived areas had higher mortality from lung cancer (ASR-E = 22.2), compared to women residing in the most deprived areas (ASR-E = 13.2), with a clear gradient among the quintiles of deprivation. For men, this pattern was reversed, with the highest mortality occurring in areas of lower socio-economic level (ASR-E = 99.0 in Q5 vs. ASR-E = 86.6 in Q1). These socio-economic inequalities remained fairly stable over time and across urban and rural areas. CONCLUSIONS Socio-economic status is strongly related to lung cancer mortality, showing opposite patterns in men and women, such that mortality is highest in women residing in the least deprived areas and men residing in the most deprived areas. Systematic surveillance of lung cancer mortality by socio-economic status may facilitate the assessment of public health interventions aimed at mitigating cancer inequalities in Spain.
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Grants
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- PROYE20023SÁNC High Resolution Study of Social Inequalities in Cancer (HiReSIC), Asociación Española Contra el Cáncer (AECC)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- Not applicable Subprograma de Vigilancia Epidemiológica del Cáncer (VICA), del CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII)
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- PI18/01593 EU/FEDER Instituto de Salud Carlos III
- Not applicable Acciones de Movilidad CIBERESP, 2022
- JC2019-039691-I Juan de la Cierva Fellowship from the Ministry of Science and the National Research Agency of Spain
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Affiliation(s)
- Daniel Redondo-Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain.
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain.
| | - Pablo Fernández-Navarro
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Olivier Nuñez
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Cancer and Environmental Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, 28029, Spain
| | - Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
| | - Juan Manuel García-Torrecillas
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Emergency and Research Unit, Torrecárdenas University Hospital, Almería, 04009, Spain
| | - Jose Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, 18071, Spain
| | - María-José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, 18012, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain
- Escuela Andaluza de Salud Pública, Granada, 18080, Spain
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13
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Li X, Jansåker F, Sundquist J, Crump C, Hamano T, Sundquist K. Neighborhood deprivation in relation to lung cancer in individuals with type 2 diabetes-A nationwide cohort study (2005-2018). PLoS One 2023; 18:e0288959. [PMID: 37478113 PMCID: PMC10361504 DOI: 10.1371/journal.pone.0288959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/07/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Neighborhood deprivation has been found associated with both type 2 diabetes and lung cancer. The aim of this study was to examine the potential association between neighborhood deprivation and lung cancer incidence or mortality in individuals diagnosed with type 2 diabetes. The results may identify a new risk or prognostic factor for lung cancer in this important subgroup and help develop a more contextual approach to prevention that includes neighborhood environment. METHODS AND FINDINGS The study population included adults (n = 613,650) aged ≥ 30 years with type 2 diabetes during 2005 to 2018 in Sweden. Cox regression was used to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incidence or mortality of lung cancer associated with neighborhood deprivation. All models were conducted in both men and women and adjusted for individual-level characteristics (e.g. age, smoking- and alcohol-related comorbidities, sociodemographic factors). The cumulative incidence and mortality for lung cancer were 1.08% (95% CI, 1.06 to 1.11) and 0.93% (0.90 to 0.95), respectively, in the study population during the study period. Neighborhood deprivation was associated with both incidence and mortality of lung cancer in patients with type 2 diabetes independently of the individual-level characteristics. In the fully adjusted models, comparing high- with low-deprivation neighborhoods, the HRs for lung cancer incidence were 1.21 (1.10 to 1.33) in men and 1.08 (0.95 to 1.21) in women. The corresponding HRs for lung cancer mortality were 1.04 (1.00 to 1.07) in men and 0.97 (0.94 to 1.00) in women. Competing risk analyses including cardiovascular mortality attenuated the results. CONCLUSION In this large cohort of individuals with type 2 diabetes, we found higher lung cancer incidence and mortality in patients living in areas with high neighborhood deprivation, even after adjusting for individual-level characteristics. These findings may help develop a more contextual approach that includes the neighborhood environment when allocating resources for disease prevention and care in patients with type 2 diabetes. These findings could also help inform clinical care for patients with type 2 diabetes, particularly those living in deprived neighborhoods.
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Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Filip Jansåker
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Clinical Microbiology, Center of Diagnostic Investigations, Rigshospitalet, Copenhagen, Denmark
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Matsue, Shimane, Japan
| | - Casey Crump
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Tsuyoshi Hamano
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Matsue, Shimane, Japan
- Department of Sports Sociology and Health Sciences, Kyoto Sangyo University, Kyoto, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Center for Community-Based Healthcare Research and Education (CoHRE), Organization for Research and Academic Information, Shimane University, Matsue, Shimane, Japan
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14
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Saint-Jacques N, Brown PE, Purcell J, Rainham DG, Terashima M, Dummer TJB. The Nova Scotia Community Cancer Matrix: A geospatial tool to support cancer prevention. Soc Sci Med 2023; 330:116038. [PMID: 37390806 DOI: 10.1016/j.socscimed.2023.116038] [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: 02/06/2023] [Revised: 05/26/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
Globally, cancer is a leading cause of death and morbidity and its burden is increasing worldwide. It is established that medical approaches alone will not solve this cancer crisis. Moreover, while cancer treatment can be effective, it is costly and access to treatment and health care is vastly inequitable. However, almost 50% of cancers are caused by potentially avoidable risk factors and are thus preventable. Cancer prevention represents the most cost-effective, feasible and sustainable pathway towards global cancer control. While much is known about cancer risk factors, prevention programs often lack consideration of how place impacts cancer risk over time. Maximizing cancer prevention investment requires an understanding of the geographic context for why some people develop cancer while others do not. Data on how community and individual level risk factors interact is therefore required. The Nova Scotia Community Cancer Matrix (NS-Matrix) study was established in Nova Scotia (NS), a small province in Eastern Canada with a population of 1 million. The study integrates small-area profiles of cancer incidence with cancer risk factors and socioeconomic conditions, to inform locally relevant and equitable cancer prevention strategies. The NS-Matrix Study includes over 99,000 incident cancers diagnosed in NS between 2001 and 2017, georeferenced to small-area communities. In this analysis we used Bayesian inference to identify communities with high and low risk for lung and bladder cancer: two highly preventable cancers with rates in NS exceeding the Canadian average, and for which key risk factors are high. We report significant spatial heterogeneity in lung and bladder cancer risk. The identification of spatial disparities relating to a community's socioeconomic profile and other spatially varying factors, such as environmental exposures, can inform prevention. Adopting Bayesian spatial analysis methods and utilizing high quality cancer registry data provides a model to support geographically-focused cancer prevention efforts, tailored to local community needs.
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Affiliation(s)
- Nathalie Saint-Jacques
- NSH Cancer Care Program, Bethune Building, 1276 South Park St, Halifax, NS, Canada; Healthy Populations Institute, Dalhousie University, 1318 Robie St., Halifax, NS, Canada.
| | - Patrick E Brown
- Department of Statistical Science, University of Toronto, Sidney Smith Hall, 100 St. George Street, Toronto, ON, Canada.
| | - Judy Purcell
- NSH Cancer Care Program, Bethune Building, 1276 South Park St, Halifax, NS, Canada.
| | - Daniel G Rainham
- School of Health and Human Performance, Dalhousie University, 5981 University Avenue, Halifax, NS, Canada; Healthy Populations Institute, Dalhousie University, 1318 Robie St., Halifax, NS, Canada.
| | - Mikiko Terashima
- School of Planning, Dalhousie University, O'Brien Hall, 5217 Morris St., Halifax, NS, Canada.
| | - Trevor J B Dummer
- School of Population and Public Health, University of British Columbia, 226 East Mall, Vancouver, BC, Canada.
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15
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Snider NG, Hastert TA, Nair M, Madhav K, Ruterbusch JJ, Schwartz AG, Peters ES, Stoffel EM, Rozek LS, Purrington KS. Area-level Socioeconomic Disadvantage and Cancer Survival in Metropolitan Detroit. Cancer Epidemiol Biomarkers Prev 2023; 32:387-397. [PMID: 36723416 PMCID: PMC10071652 DOI: 10.1158/1055-9965.epi-22-0738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/27/2022] [Accepted: 01/09/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Racial segregation is linked to poorer neighborhood quality and adverse health conditions among minorities, including worse cancer outcomes. We evaluated relationships between race, neighborhood social disadvantage, and cancer survival. METHODS We calculated overall and cancer-specific survival for 11,367 non-Hispanic Black (NHB) and 29,481 non-Hispanic White (NHW) individuals with breast, colorectal, lung, or prostate cancer using data from the Metropolitan Detroit Cancer Surveillance System. The area deprivation index (ADI) was used to measure social disadvantage at the census block group level, where higher ADI is associated with poorer neighborhood factors. Associations between ADI and survival were estimated using Cox proportional hazards mixed-effects models accounting for geographic grouping and adjusting for demographic and clinical factors. RESULTS Increasing ADI quintile was associated with increased overall mortality for all four cancer sites in multivariable-adjusted models. Stratified by race, these associations remained among breast (NHW: HR = 1.16, P < 0.0001; NHB: HR = 1.20, P < 0.0001), colorectal (NHW: HR = 1.11, P < 0.0001; NHB: HR = 1.09, P = 0.00378), prostate (NHW: HR = 1.18, P < 0.0001; NHB: HR = 1.18, P < 0.0001), and lung cancers (NHW: HR = 1.06, P < 0.0001; NHB: HR = 1.07, P = 0.00177). Cancer-specific mortality estimates were similar to overall mortality. Adjustment for ADI substantially attenuated the effects of race on mortality for breast [overall proportion attenuated (OPA) = 47%, P < 0.0001; cancer-specific proportion attenuated (CSPA) = 37%, P < 0.0001] prostate cancer (OPA = 51%, P < 0.0001; CSPA = 56%, P < 0.0001), and colorectal cancer (OPA = 69%, P = 0.032; CSPA = 36%, P = 0.018). CONCLUSIONS Area-level socioeconomic disadvantage is related to cancer mortality in a racially diverse population, impacting racial differences in cancer mortality. IMPACT Understanding the role of neighborhood quality in cancer survivorship could improve community-based intervention practices.
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Affiliation(s)
- Natalie G. Snider
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Theresa A. Hastert
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Mrudula Nair
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - K.C. Madhav
- Department of Internal Medicine, Yale School of Medicine, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, Connecticut
| | - Julie J. Ruterbusch
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Ann G. Schwartz
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Edward S. Peters
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Elena M. Stoffel
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Laura S. Rozek
- Department of Oncology, Georgetown University School of Medicine, Washington, DC
| | - Kristen S. Purrington
- Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
- Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
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Neighborhood deprivation, racial segregation and associations with cancer risk and outcomes across the cancer-control continuum. Mol Psychiatry 2023; 28:1494-1501. [PMID: 36869227 DOI: 10.1038/s41380-023-02006-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 03/05/2023]
Abstract
The racial/ethnic disparities in cancer incidence and outcome are partially due to the inequities in neighborhood advantage. Mounting evidences supported a link between neighborhood deprivation and cancer outcomes including higher mortality. In this review, we discuss some of the findings related to work on area-level neighborhood variables and cancer outcomes, and the potential biological and built/natural environmental mechanisms that might explain this link. Studies have also shown that residents of deprived neighborhoods or of racially or economically segregated neighborhoods have worse health outcomes than residents of more affluent neighborhoods and/or less racially or economically segregated neighborhoods, even after adjusting for the individual-level socioeconomic status. To date, little research has been conducted investigating the biological mediators that may play roles in the associations of neighborhood deprivation and segregation with cancer outcomes. The psychophysiological stress induced by neighborhood disadvantage among people living in these neighborhoods could be a potential underlying biological mechanism. We examined a number of chronic stress-related pathways that may potentially mediate the relationship between area-level neighborhood factors and cancer outcomes, including higher allostatic load, stress hormones, altered epigenome and telomere maintenance and biological aging. In conclusion, the extant evidence supports the notion that neighborhood deprivation and racial segregation have unfavorable impacts on cancer. Understanding how neighborhood factors influence the biological stress response has the potential to inform where and what types of resources are needed within the community to improve cancer outcomes and reduce disparities. More studies are warranted to directly assess the role of biological and social mechanisms in mediating the relationship between neighborhood factors and cancer outcomes.
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Neighborhood disadvantage is associated with KRAS-mutated non-small cell lung cancer risk. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04455-7. [DOI: 10.1007/s00432-022-04455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
Abstract
Purpose
It remains unclear why individuals living in disadvantaged neighborhoods have shorter non-small cell lung cancer (NSCLC) survival. It is possible that living in these deprived areas is linked with increased risk of developing aggressive NSCLC biology. Here, we explored the association of somatic KRAS mutations, which are associated with shorter survival in NSCLC patients, and 11 definitions of neighborhood disadvantage spanning socioeconomic and structural environmental elements.
Methods
We analyzed data from 429 NSCLC patients treated at a Comprehensive Cancer Center from 2015 to 2018. Data were abstracted from medical records and each patient’s home address was used to assign publicly available indices of neighborhood disadvantage. Prevalence Ratios (PRs) for the presence of somatic KRAS mutations were estimated using modified Poisson regression models adjusted for age, sex, smoking status, race/ethnicity, educational attainment, cancer stage, and histology.
Results
In the NSCLC cohort, 29% had KRAS mutation-positive tumors. We found that five deprivation indices of socioeconomic disadvantage were associated with KRAS mutation. A one decile increase in several of these socioeconomic disadvantage indices was associated with a 1.06 to 1.14 increased risk of KRAS mutation. Measures of built structural environment were not associated with KRAS mutation status.
Conclusion
Socioeconomic disadvantage at the neighborhood level is associated with higher risk of KRAS mutation while disadvantage related to built environmental structural measures was inversely associated. Our results indicate not only that neighborhood disadvantage may contribute to aggressive NSCLC biology, but the pathways linking biology to disadvantage are likely operating through socioeconomic-related stress.
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Ammitzbøll G, Levinsen AKG, Kjær TK, Ebbestad FE, Horsbøl TA, Saltbæk L, Badre-Esfahani SK, Joensen A, Kjeldsted E, Halgren Olsen M, Dalton SO. Socioeconomic inequality in cancer in the Nordic countries. A systematic review. Acta Oncol 2022; 61:1317-1331. [DOI: 10.1080/0284186x.2022.2143278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gunn Ammitzbøll
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | | | - Trille Kristina Kjær
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Freja Ejlebæk Ebbestad
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Trine Allerslev Horsbøl
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lena Saltbæk
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Sara Koed Badre-Esfahani
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Andrea Joensen
- Section of Epidemiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva Kjeldsted
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
| | - Maja Halgren Olsen
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
- Danish Research Center for Equality in Cancer (COMPAS), Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark
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Sun Y, Wu J, Yoon HS, Buchowski MS, Cai H, Deppen SA, Steinwandel MD, Zheng W, Shu XO, Blot WJ, Cai Q. Associations of Dietary Intakes of Carotenoids and Vitamin A with Lung Cancer Risk in a Low-Income Population in the Southeastern United States. Cancers (Basel) 2022; 14:5159. [PMID: 36291941 PMCID: PMC9600198 DOI: 10.3390/cancers14205159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
Observational studies found inverse associations of dietary carotenoids and vitamin A intakes with lung cancer risk. However, interventional trials among high-risk individuals showed that β-carotene supplements increased lung cancer risk. Most of the previous studies were conducted among European descendants or Asians. We prospectively examined the associations of lung cancer risk with dietary intakes of carotenoids and vitamin A in the Southern Community Cohort Study, including 65,550 participants with 1204 incident lung cancer cases. Multivariate Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Lung cancer cases had lower energy-adjusted dietary intakes of all carotenoids and vitamin A than non-cases. However, dietary intakes of carotenoids and vitamin A were not associated with overall lung cancer risk. A significant positive association of dietary vitamin A intake with lung cancer risk was observed among current smokers (HRQ4 vs. Q1 = 1.23; 95% CI: 1.02-1.49; Ptrend = 0.01). In addition, vitamin A intake was associated with an increased risk of adenocarcinoma among African Americans (HRQ4 vs. Q1 = 1.55; 95%CI: 1.08-2.21; Ptrend = 0.03). Dietary lycopene intake was associated with an increased risk of lung cancer among former smokers (HRQ4 vs. Q1 = 1.50; 95% CI: 1.04-2.17; Ptrend = 0.03). There are positive associations of dietary β-cryptoxanthin intake with squamous carcinoma risk (HRQ4 vs. Q1 = 1.49; 95% CI: 1.03-2.15; Ptrend = 0.03). Further studies are warranted to confirm our findings.
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Affiliation(s)
- Yan Sun
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Jie Wu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Hyung-Suk Yoon
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Maciej S. Buchowski
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine and Vanderbilt Epidemiology Center, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Hui Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Stephen A. Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Veterans Affairs Hospital, Tennessee Valley VA Healthcare System, Nashville, TN 37212, USA
| | - Mark D. Steinwandel
- International Epidemiology Field Station, Vanderbilt Institute for Clinical and Translational Research, Rockville, MD 20850, USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Xiao-Ou Shu
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - William J. Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, 1161 21st Avenue South, Nashville, TN 37232, USA
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20
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Wagle NS, Park S, Washburn D, Ohsfeldt RL, Rich NE, Singal AG, Kum H. Racial, Ethnic, and Socioeconomic Disparities in Curative Treatment Receipt and Survival in Hepatocellular Carcinoma. Hepatol Commun 2022; 6:1186-1197. [PMID: 34796703 PMCID: PMC9035560 DOI: 10.1002/hep4.1863] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/19/2021] [Accepted: 10/30/2021] [Indexed: 12/21/2022] Open
Abstract
Hepatocellular carcinoma (HCC) disproportionately affects racial, ethnic, and low socioeconomic status (SES) populations. However, the interaction between race, ethnicity, and neighborhood SES in HCC prognosis is not well explored. This study evaluates the interaction between race and ethnicity and neighborhood SES on curative treatment utilization and overall survival among patients with HCC in the United States. We conducted a retrospective cohort study of 13,874 patients aged ≥65 years diagnosed with HCC from 2001 through 2015 using the Surveillance, Epidemiology, and End Results Medicare-linked database. We performed multivariable logistic regression to examine the association between race, ethnicity, and curative treatment receipt across SES. We also evaluated the association between curative treatment receipt and overall survival using a Cox proportional hazards model. Among 13,874 patients, only 2,617 (18.9%) patients received curative treatment. Overall, Black patients had lower odds of receiving curative treatment than White patients (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.64-0.91). When stratified by neighborhood SES, Black patients living in high-poverty neighborhoods had lower odds of curative treatment receipt (OR, 0.64; 95% CI, 0.49-0.84) and worse survival (hazard ratio, 1.13; 95% CI, 1.02-1.25). Conversely, Hispanic and Asian patients had similar curative treatment receipt compared to White patients across all socioeconomic levels. Conclusion: Disparities in curative treatment receipt and overall survival are pronounced between Black and White patients. Black-White disparities appear to be moderated by neighborhood SES and are particularly evident among those living in high-poverty neighborhoods.
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Affiliation(s)
- Nikita Sandeep Wagle
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Health Policy and ManagementTexas A&M School of Public HealthCollege StationTXUSA
| | - Sulki Park
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Industrial and Systems EngineeringTexas A&M UniversityCollege StationTXUSA
| | - David Washburn
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Health Policy and ManagementTexas A&M School of Public HealthCollege StationTXUSA
| | - Robert L. Ohsfeldt
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Health Policy and ManagementTexas A&M School of Public HealthCollege StationTXUSA
| | - Nicole E. Rich
- Division of Digestive and Liver DiseasesUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Amit G. Singal
- Division of Digestive and Liver DiseasesUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Hye‐Chung Kum
- Population Informatics LabTexas A&M School of Public HealthCollege StationTXUSA
- Department of Health Policy and ManagementTexas A&M School of Public HealthCollege StationTXUSA
- Department of Industrial and Systems EngineeringTexas A&M UniversityCollege StationTXUSA
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21
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The Effect of Neighborhood Deprivation on Mortality in Newly Diagnosed Diabetes Patients: A Countrywide Population-Based Korean Retrospective Cohort Study, 2002-2013. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074324. [PMID: 35410005 PMCID: PMC8998590 DOI: 10.3390/ijerph19074324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
Abstract
Background: Neighborhood environmental factors along with individual factors are beginning to make a mark as factors which influence individual health outcomes. The goal of this study is to look at the combined impact of individual and neighborhood socioeconomic status on all-cause mortality in diabetic patients who have just been diagnosed. Methods: The Korean National Health Insurance (2002–2013) was employed in this cohort research, which used a stratified random sample. During the years 2003–2006, a total of 15,882 individuals who were newly diagnosed with diabetes and using oral disease-controlling medication were included in the study. Individual income and neighborhood deprivation index were used to examine the combined effect on all-cause mortality. The frailty model was performed using Cox’s proportional hazard regression. Results: During the study period, 28.3 percent (n = 4493) of the 15,882 eligible individuals died. In a Cox regression analysis after adjusting for all covariates, with advantaged and disadvantaged neighborhoods classified according to individual household income, the adjusted HR for patients living in a disadvantaged area was higher compared to patients living in an advantaged area in patients with middle income, compared to the reference group (a high income within an advantaged neighborhood) (HR, 1.22; 95% CI, 1.09–1.35; HR, 1.13; 95% CI, 1.02–1.25, respectively). The adjusted HR for patients with low income who lived in a disadvantaged location was greater than for patients who lived in an advantaged area (HR, 1.34; 95% CI, 1.18–1.53 vs. HR, 1.28; 95% CI, 1.14–1.49). Conclusions: Individual SES has a greater impact on all-cause mortality among diabetic patients when they live in a low-income neighborhood.
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22
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Pizzato M, Martinsen JI, Heikkinen S, Vignat J, Lynge E, Sparén P, La Vecchia C, Pukkala E, Vaccarella S. Socioeconomic status and risk of lung cancer by histological subtype in the Nordic countries. Cancer Med 2022; 11:1850-1859. [PMID: 35166068 PMCID: PMC9041078 DOI: 10.1002/cam4.4548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While the excess in lung cancer risk among lower socioeconomic status individuals has been widely described, the magnitude of this association across lung cancer subtypes, as well as histotype-related long-term incidence trends, are inconclusively reported. AIMS We explored the variation in the incidence of the three main lung cancer histotypes (i.e. squamous cell carcinoma, small cell carcinoma and adenocarcinoma) by socioeconomic status (SES, i.e. upper and lower white collar, upper and lower blue collar, and farming/forestry/fishing) in the adult population of four Nordic countries (i.e. Sweden, Norway, Finland and Denmark). MATERIALS & METHODS We have used data from the Nordic Occupational Cancer Study (NOCCA), computing age-standardized incidence rates per 100,000 person-years truncated at ages 50-69 years, by sex, histotype, country and SES, for the period 1971-2005. We estimated relative risks and the corresponding 95% confidence intervals through Poisson regression models, including terms for SES, age, sex and country, as indicated. RESULTS A clear socioeconomic gradient, with a progressive increase in lung cancer risk as SES level decreases, was observed in all subtypes and in both sexes. Favourable lung cancer incidence trends were seen among men for squamous cell and small cell carcinomas, although for adenocarcinomas rates were increasing everywhere except for Finland. Among women, upward temporal trends were seen in all SES groups and for all subtypes, although rates increased to a greater extent for low, compared to high, SES, especially in Denmark and Norway. Farmers showed comparatively lower risks compared to other SES categories. DISCUSSION This prospective cohort study shows that substantial socioeconomic inequalities in the incidence of the most important lung cancer histotypes exist in the Nordic Countries, and that these inequalities are on the rise, especially among women. CONCLUSION Smoking habits are likely to largely explain the observed social gradient for lung cancer histotypes in both sexes.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | | | | | - Jerome Vignat
- International Agency for Research on CancerLyonFrance
| | - Elsebeth Lynge
- Nykøbing Falster HospitalUniversity of CopenhagenDenmark
| | - Pär Sparén
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholm
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Eero Pukkala
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland
- Faculty of Social Sciences, Tampere UniversityTampereFinland
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Lung, Breast and Colorectal Cancer Incidence by Socioeconomic Status in Spain: A Population-Based Multilevel Study. Cancers (Basel) 2021; 13:cancers13112820. [PMID: 34198798 PMCID: PMC8201149 DOI: 10.3390/cancers13112820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/20/2022] Open
Abstract
Socioeconomic inequalities in cancer incidence are not well documented in southern Europe. We aim to study the association between socioeconomic status (SES) and colorectal, lung, and breast cancer incidence in Spain. We conducted a multilevel study using data from Spanish population-based cancer registries, including incident cases diagnosed for the period 2010-2013 in nine Spanish provinces. We used Poisson mixed-effects models, including the census tract as a random intercept, to derive cancer incidence rate ratios by SES, adjusted for age and calendar year. Male adults with the lowest SES, compared to those with the highest SES, showed weak evidence of being at increased risk of lung cancer (risk ratio (RR): 1.18, 95% CI: 0.94-1.46) but showed moderate evidence of being at reduced risk of colorectal cancer (RR: 0.84, 95% CI: 0.74-0.97). Female adults with the lowest SES, compared to those with the highest SES, showed strong evidence of lower breast cancer incidence with 24% decreased risk (RR: 0.76, 95% CI: 0.68-0.85). Among females, we did not find evidence of an association between SES and lung or colorectal cancer. The associations found between SES and cancer incidence in Spain are consistent with those obtained in other European countries.
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Tetzlaff F, Epping J, Tetzlaff J, Golpon H, Geyer S. Socioeconomic inequalities in lung cancer - a time trend analysis with German health insurance data. BMC Public Health 2021; 21:538. [PMID: 33740928 PMCID: PMC7977592 DOI: 10.1186/s12889-021-10576-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/07/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lung Cancer (LC) is one of the most prevalent cancer diseases. Due to the lack of databases which allow the combination of information on individual socioeconomic status (SES) and cancer incidence, research on social inequalities in LC among the German population is rare. The aim of the study is to analyse time trends in social inequalities in LC in Germany. METHODS The analyses are based on data of a large statutory health insurance provider. The data contain information on diagnoses, occupation and education (working age), and income (full age range) of the insurance population. Trends were analysed for two subpopulations (retirement age and working age) and stratified by sex. The analyses are based on incidence rates and proportional hazard models spanning the periods 2006-2009, 2010-2013 and 2014-2017. RESULTS Incidence rates declined in men but increased in women. For men, inequalities were strongest in terms of income and the decline in incidence was most pronounced in middle- and higher-income men. Among women at retirement age, a reversed income gradient was found which disappeared in the second period. The educational gradient among the working-age population decreased over time due to the trend towards increasing incidence among individuals with higher education. Declining gradients were also found for occupational position. CONCLUSION The findings reveal considerable inequalities in LC and that trends vary with respect to SES, sex and age. Widening income inequalities were found in the retired population, while educational and occupational inequalities tend to narrow among the working-age population.
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Affiliation(s)
- Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany.
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Heiko Golpon
- Department of Pneumology, Hannover Medical School, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Gariazzo C, Binazzi A, Alfò M, Massari S, Stafoggia M, Marinaccio A. Predictors of Lung Cancer Risk: An Ecological Study Using Mortality and Environmental Data by Municipalities in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1896. [PMID: 33669318 PMCID: PMC7922734 DOI: 10.3390/ijerph18041896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 01/04/2023]
Abstract
Lung cancer (LC) mortality remains a consistent part of the total deaths occurring worldwide. Its etiology is complex as it involves multifactorial components. This work aims in providing an epidemiological assessment on occupational and environmental factors associated to LC risk by means of an ecological study involving the 8092 Italian municipalities for the period 2006-2015. We consider mortality data from mesothelioma as proxy of asbestos exposure, as well as PM2.5 and radon levels as a proxy of environmental origin. The compensated cases for occupational respiratory diseases, urbanization and deprivation were included as predictors. We used a negative binomial distribution for the response, with analysis stratified by gender. We estimated that asbestos is responsible for about 1.1% (95% CI: 0.8, 1.4) and 0.5% (95% CI: 0.2, 0.8) of LC mortality in males and females, respectively. The corresponding figures are 14.0% (95% CI: 12.5, 15.7) and 16.3% (95% CI: 16.2, 16.3) for PM2.5 exposure, and 3.9% (95% CI: 3.5, 4.2) and 1.6% (95% CI: 1.4, 1.7) for radon exposure. The assessment of determinants contribution to observed LC deaths is crucial for improving awareness of its origin, leading to increase the equity of the welfare system.
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Affiliation(s)
- Claudio Gariazzo
- Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy; (A.B.); (S.M.); (A.M.)
| | - Alessandra Binazzi
- Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy; (A.B.); (S.M.); (A.M.)
| | - Marco Alfò
- Department of Statistic, University of Roma “Sapienza”, 00185 Rome, Italy;
| | - Stefania Massari
- Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy; (A.B.); (S.M.); (A.M.)
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, 00154 Rome, Italy;
| | - Alessandro Marinaccio
- Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy; (A.B.); (S.M.); (A.M.)
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Chakravarthy R, Stallings SC, Velez Edwards DR, Zhao SK, Conway D, Rao JS, Aldrich MC, Kobetz E, Wilkins CH. Determinants of stage at diagnosis of HPV-related cancer including area deprivation and clinical factors. J Public Health (Oxf) 2021; 44:18-27. [PMID: 33512511 PMCID: PMC8904191 DOI: 10.1093/pubmed/fdaa246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 07/24/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Collecting social determinants of health in electronic health records is time-consuming. Meanwhile, an Area Deprivation Index (ADI) aggregates sociodemographic information from census data. The objective of this study was to ascertain whether ADI is associated with stage of human papillomavirus (HPV)-related cancer at diagnosis. Methods We tested for the association between the stage of HPV-related cancer presentation and ADI as well as the association between stage and the value of each census-based measure using ordered logistic regression, adjusting for age, race and sex. Results Among 3247 cases of HPV-related cancers presenting to an urban academic medical center, the average age at diagnosis was 57. The average stage at diagnosis was Surveillance, Epidemiology and End Results Stage 3. In the study population, 43% of patients were female and 87% were white. In this study population, there was no association between stage of HPV-related cancer presentation and either aggregate or individual census variables. Conclusions These results may reflect insufficient sample size, a lack of socio-demographic diversity in our population, or suggest that simplifying social determinants of health into a single geocoded index is not a reliable surrogate for assessing a patient’s risk for HPV-related cancer.
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Affiliation(s)
| | - Sarah C Stallings
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sifang Kathy Zhao
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas Conway
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Sunil Rao
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA.,Division of Biostatistics, University of Miami School of Medicine, Miami, FL, USA
| | - Melinda C Aldrich
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Erin Kobetz
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami, Coral Gables, FL, USA
| | - Consuelo H Wilkins
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Meharry-Vanderbilt Alliance, Nashville, TN, USA.,Office of Health Equity, Vanderbilt University Medical Center, Nashville, TN, USA
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Estimation of the Potentially Avoidable Excess Deaths Associated with Socioeconomic Inequalities in Cancer Survival in Germany. Cancers (Basel) 2021; 13:cancers13020357. [PMID: 33478065 PMCID: PMC7835812 DOI: 10.3390/cancers13020357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 12/15/2022] Open
Abstract
Many countries have reported survival inequalities due to regional socioeconomic deprivation. To quantify the potential gain from eliminating cancer survival disadvantages associated with area-based deprivation in Germany, we calculated the number of avoidable excess deaths. We used population-based cancer registry data from 11 of 16 German federal states. Patients aged ≥15 years diagnosed with an invasive malignant tumor between 2008 and 2017 were included. Area-based socioeconomic deprivation was assessed using the quintiles of the German Index of Multiple Deprivation (GIMD) 2010 on a municipality level nationwide. Five-year age-standardized relative survival for 25 most common cancer sites and for total cancer were calculated using period analysis. Incidence and number of avoidable excess deaths in Germany in 2013-2016 were estimated. Summed over the 25 cancer sites, 4100 annual excess deaths (3.0% of all excess deaths) could have been avoided each year in Germany during the period 2013-2016 if relative survival were in all regions comparable with the least deprived regions. Colorectal, oral and pharynx, prostate, and bladder cancer contributed the largest numbers of avoidable excess deaths. Our results provide a good basis to estimate the potential of intervention programs for reducing socioeconomic inequalities in cancer burden in Germany.
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Tetzlaff F, Epping J, Golpon H, Tetzlaff J. Compression, expansion, or maybe both? Growing inequalities in lung cancer in Germany. PLoS One 2020; 15:e0242433. [PMID: 33216766 PMCID: PMC7679006 DOI: 10.1371/journal.pone.0242433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/02/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Lung Cancer (LC) is one of the most common malign diseases worldwide. So far, it is unclear if the development of LC incidence and mortality leads to morbidity compression or expansion and whether these developments differ by socioeconomic characteristics. This study analyses time trends in social and gender inequalities in life years with and without LC in Germany. METHODS The study is based on data of a large German statutory health insurance provider (N = 2,511,790). Incidence and mortality risks were estimated from multistate survival models. Trends in life years with and without LC were analysed using multistate life table analyses. All analyses were performed separately for gender, time period (2006-2009 and 2014-2017), and income group (<60% and ≥60% of the German average income). RESULTS Among men, declining LC incidence rates resulted in gains of life years free of LC and declining LC- affected life years and led to a relative compression, which was strongest in men with higher incomes. Among women, a clear increase in life years with LC led to an expansion of the lifespan affected by LC. This expansion was mainly driven by increasing incidence rates in women with low incomes. Overall, income inequalities in LC increased in both genders. CONCLUSIONS Our analyses reveal that developments in the length of life affected by LC differed substantially by gender and income and led to widening health inequalities over time. Public health efforts should mainly focus on vulnerable groups to reduce the persisting social inequalities in LC.
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Affiliation(s)
- Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany
| | - Heiko Golpon
- Department of Pneumology, Hannover Medical School, Hanover, Germany
| | - Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Arora KS, Ascha M, Wilkinson B, Verbus E, Montague M, Morris J, Einstadter D. Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization. BMC Public Health 2020; 20:1440. [PMID: 32962666 PMCID: PMC7509918 DOI: 10.1186/s12889-020-09540-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adequacy of prenatal care is associated with fulfillment of postpartum sterilization requests, though it is unclear whether this relationship is indicative of broader social and structural determinants of health or reflects the mandatory Medicaid waiting period required before sterilization can occur. We evaluated the relationship between neighborhood disadvantage (operationalized by the Area Deprivation Index; ADI) and the likelihood of undergoing postpartum sterilization. METHODS Secondary analysis of a single-center retrospective cohort study examining 8654 postpartum patients from 2012 to 2014, of whom 1332 (15.4%) desired postpartum sterilization (as abstracted from the medical record at time of delivery hospitalization discharge) and for whom ADI could be calculated via geocoding their home address. We determined the association between ADI and sterilization completion, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery via logistic regression and time to sterilization via Cox proportional hazards regression. RESULTS Of the 1332 patients included in the analysis, patients living in more disadvantaged neighborhoods were more likely to be younger, more parous, delivered vaginally, Black, unmarried, not college educated, and insured via Medicaid. Compared to patients living in less disadvantaged areas, patients living in more disadvantaged areas were less likely to obtain sterilization (44.8% vs. 53.5%, OR 0.84, 95% CI 0.75-0.93), experienced greater delays in the time to sterilization (HR 1.23, 95% CI 1.06-1.44), were less likely to attend postpartum care (58.9% vs 68.9%, OR 0.86, CI 0.79-0.93), and were more likely to have a subsequent pregnancy within a year of delivery (15.1% vs 10.4%, OR 1.56, 95% CI 1.10-1.94). In insurance-stratified analysis, for patients with Medicaid, but not private insurance, as neighborhood disadvantage increased, the rate of postpartum sterilization decreased. The rate of subsequent pregnancy was positively associated with neighborhood disadvantage for both Medicaid as well as privately insured patients. CONCLUSION Living in an area with increased neighborhood disadvantage is associated with worse outcomes in terms of desired postpartum sterilization, especially for patients with Medicaid insurance. While revising the Medicaid sterilization policy is important, addressing social determinants of health may also play a powerful role in reducing inequities in fulfillment of postpartum sterilization.
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Affiliation(s)
- Kavita Shah Arora
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Mustafa Ascha
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, OH, USA
| | - Barbara Wilkinson
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Emily Verbus
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Mary Montague
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jane Morris
- Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Douglas Einstadter
- Center for Health Care Research and Policy and the Departments of Medicine, and Population and Quantitative Health Sciences, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Adie Y, Kats DJ, Tlimat A, Perzynski A, Dalton J, Gunzler D, Tarabichi Y. Neighborhood Disadvantage and Lung Cancer Incidence in Ever-Smokers at a Safety Net Health-Care System: A Retrospective Study. Chest 2020; 157:1021-1029. [PMID: 31862438 PMCID: PMC7268431 DOI: 10.1016/j.chest.2019.11.033] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/29/2019] [Accepted: 11/21/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Neighborhood circumstances have an influence on multiple health outcomes, but the association between neighborhood conditions and lung cancer incidence has not been studied in sufficient detail. The goal of this study was to understand whether neighborhood conditions are independently associated with lung cancer incidence in ever-smokers after adjusting for individual smoking exposure and other risk factors. METHODS A cohort of ever-smokers aged ≥ 55 years was assembled from 19 years of electronic health record data from our academic community health-care system. Patient demographic characteristics and other measures known to be associated with lung cancer were ascertained. Patient addresses at their index visit were geocoded to the census block group level to determine the area deprivation index (ADI), drawn from 5-year estimates from the American Community Survey. A multivariate Cox proportional hazards model was fit to assess the association between ADI and time to lung cancer diagnosis. Tests of statistical significance were two-sided. RESULTS The study included 19,867 male subjects and 21,748 female subjects. Fifty-three percent of the patients were white, 38% were black, and 5% were Hispanic. Of these, 1,149 developed lung cancer. After adjusting for known risk factors, patients residing in the most disadvantaged areas had a significantly increased incidence of lung cancer compared with those in the least disadvantaged areas (hazard ratio, 1.29; 95% CI 1.07-1.55). CONCLUSIONS Census-derived estimates of neighborhood conditions have a powerful association with lung cancer incidence, even when adjusting for individual variables. Further research investigating the mechanisms that link neighborhood conditions to lung cancer is warranted.
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Affiliation(s)
- Yosra Adie
- Center for Reducing Health Disparities, The MetroHealth System, Cleveland, OH
| | - Daniel J Kats
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Abdulhakim Tlimat
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH
| | - Adam Perzynski
- Center for Health Care Research and Policy, The MetroHealth System, Cleveland, OH
| | - Jarrod Dalton
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Douglas Gunzler
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH
| | - Yasir Tarabichi
- Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH; Division of Pulmonary, Critical Care and Sleep Medicine, The MetroHealth System, Cleveland, OH.
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Socioeconomic inequalities in cancer incidence in Europe: a comprehensive review of population-based epidemiological studies. Radiol Oncol 2020; 54:1-13. [PMID: 32074075 PMCID: PMC7087422 DOI: 10.2478/raon-2020-0008] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Background Since the end of the previous century, there has not been a comprehensive review of European studies on socioeconomic inequality in cancer incidence. In view of recent advances in data source linkage and analytical methods, we aimed to update the knowledge base on associations between location-specific cancer incidence and individual or area-level measures of socio-economic status (SES) among European adults. Materials and methods We systematically searched three databases (PubMed, Scopus and Web of Science) for articles on cancer incidence and SES. Qualitative synthesis was performed on the 91 included English language studies, published between 2000 and 2019 in Europe, which focused on adults, relied on cancer registry data and reported on relative risk (RR) estimates. Results Adults with low SES have increased risk of head and neck, oesophagogastric, liver and gallbladder, pancreatic, lung, kidney, bladder, penile and cervical cancers (highest RRs for lung, head and neck, stomach and cervix). Conversely, high SES is linked with increased risk of thyroid, breast, prostate and skin cancers. Central nervous system and haematological cancers are not associated with SES. The positive gap in testicular cancer has narrowed, while colorectal cancer shows a varying pattern in different countries. Negative associations are generally stronger for men compared to women. Conclusions In Europe, cancers in almost all common locations are associated with SES and the inequalities can be explained to a varying degree by known life-style related factors, most notably smoking. Independent effects of many individual and area SES measures which capture different aspects of SES can also be observed.
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Kurotani K, Honjo K, Nakaya T, Ikeda A, Mizoue T, Sawada N, Tsugane S. Diet Quality Affects the Association between Census-Based Neighborhood Deprivation and All-Cause Mortality in Japanese Men and Women: The Japan Public Health Center-Based Prospective Study. Nutrients 2019; 11:nu11092194. [PMID: 31547299 PMCID: PMC6770038 DOI: 10.3390/nu11092194] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Individuals residing in more deprived areas with a lower diet quality might have a higher mortality risk. We aimed to examine the association between deprivation within an area and all-cause mortality risk according to diet quality. Methods: We conducted a population-based prospective study on 27,994 men and 33,273 women aged 45–75 years. Neighborhood deprivation was assessed using the Japanese areal deprivation index (ADI). Dietary intakes were assessed using a validated 147-item food frequency questionnaire. Results: Individuals residing in the most deprived area had the lowest dietary scores. During the 16.7-year follow-up, compared to individuals with a high quality diet residing in the least deprived area, individuals with a low quality diet had a higher risk of mortality according to increment of ADI (p trend = 0.03); the multivariate-adjusted hazard ratio (95% confidence interval) was 1.09 (0.999–1.19), 1.17 (1.08–1.27), and 1.19 (1.08–1.32) in those residing in the lowest through the highest third of ADI, respectively. However, individuals with a high quality diet had no significant association between ADI and mortality. Conclusion: A well-balanced diet may prevent early death associated with neighborhood socioeconomic status among those residing in highly deprived areas.
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Affiliation(s)
- Kayo Kurotani
- Department of Nutritional Epidemiology and Shokuiku, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo 162-8636, Japan.
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
| | - Kaori Honjo
- Psychology and Behavior Sciences, Osaka Medical College, Osaka 569-0801, Japan.
| | - Tomoki Nakaya
- Graduate School of Environmental Studies, Tohoku University, Miyagi 980-8577, Japan.
| | - Ai Ikeda
- Department of Public Health, Juntendo University School of Medicine, Tokyo 113-0033, Japan.
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine, Tokyo 162-8655, Japan.
| | - Norie Sawada
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo 104-0045, Japan.
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo 104-0045, Japan.
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Hu H, Zhou Y, Zhang M, Ding R. Prognostic value of RASSF1A methylation status in non-small cell lung cancer (NSCLC) patients: A meta-analysis of prospective studies. Biomarkers 2019; 24:207-216. [PMID: 30764677 DOI: 10.1080/1354750x.2019.1583771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: Ras association domain family 1 A (RASSF1A) has been regarded as a biomarker predicting the prognosis of non-small cell lung cancer (NSCLC), but previous findings are inconsistent. This meta-analysis of prospective studies aimed to assess the value of RASSF1A methylation in predicting the prognosis of NSCLC patients. Methods: Studies were searched in PubMed and Web of Science. The estimates of the effects and the corresponding 95% confidence intervals (95% CIs) were used for the analyses. The overall effects of RASSF1A methylation on overall survival (OS) were estimated, after which subgroup analysis based on regions was conducted. Sensitivity analyses were conducted to restrict the studies with certain features. Results: A total of 16 studies with 2210 participants were included in this meta-analysis. The overall analysis result indicated that RASSF1A methylation had no statistically significant effects on OS of NSCLC patients (HR = 1.28; 95% CI 0.86-1.70), which were confirmed by the subgroup analysis. However, the sensitivity analysis indicated that RASSF1A methylation from lung cancer tissues was significantly associated with lower OS (HR = 1.24; 95% CI 1.04-1.45). Conclusion: RASSF1A methylation in lung cancer tissue can serve as a prognostic factor of NSCLC. More studies are needed to uncover the underlying mechanisms.
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Affiliation(s)
- Hao Hu
- a First School of Clinical Medicine , Anhui Medical University , Hefei , Anhui , China
| | - Yuefei Zhou
- a First School of Clinical Medicine , Anhui Medical University , Hefei , Anhui , China
| | - Min Zhang
- b School of Public Health , Anhui Medical University , Hefei , Anhui , China
| | - Rui Ding
- b School of Public Health , Anhui Medical University , Hefei , Anhui , China
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Sanderson M, Aldrich MC, Levine RS, Kilbourne B, Cai Q, Blot WJ. Neighbourhood deprivation and lung cancer risk: a nested case-control study in the USA. BMJ Open 2018; 8:e021059. [PMID: 30206077 PMCID: PMC6144393 DOI: 10.1136/bmjopen-2017-021059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To examine the association between neighbourhood deprivation and lung cancer risk. DESIGN Nested case-control study. SETTING Southern Community Cohort Study of persons residing in 12 states in the southeastern USA. PARTICIPANTS 1334 cases of lung cancer and 5315 controls. PRIMARY OUTCOME MEASURE Risk of lung cancer. RESULTS After adjustment for smoking status and other confounders, and additional adjustment for individual-level measures of socioeconomic status (SES), there was no monotonic increase in risk with worsening deprivation score overall or within sex and race groups. There was an increase among current and shorter term former smokers (p=0.04) but not among never and longer term former smokers. There was evidence of statistically significant interaction by sex among whites, but not blacks, in which the effect of worsening deprivation on lung cancer existed in males but not in females. CONCLUSIONS Area-level measures of SES were associated with lung cancer risk in current and shorter term former smokers only in this population.
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Affiliation(s)
- Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Melinda C Aldrich
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert S Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Barbara Kilbourne
- Department of Sociology, Tennessee State University, Nashville, Tennessee, USA
| | - Qiuyin Cai
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - William J Blot
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Hagedoorn P, Vandenheede H, Vanthomme K, Gadeyne S. Socioeconomic position, population density and site-specific cancer mortality: A multilevel analysis of Belgian adults, 2001-2011. Int J Cancer 2017; 142:23-35. [DOI: 10.1002/ijc.31031] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/28/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Paulien Hagedoorn
- Interface Demography, Department of Sociology, Faculty of Economic and Social Sciences and Solvay Business School; Vrije Universiteit Brussel; Brussels Belgium
| | - Hadewijch Vandenheede
- Interface Demography, Department of Sociology, Faculty of Economic and Social Sciences and Solvay Business School; Vrije Universiteit Brussel; Brussels Belgium
| | - Katrien Vanthomme
- Interface Demography, Department of Sociology, Faculty of Economic and Social Sciences and Solvay Business School; Vrije Universiteit Brussel; Brussels Belgium
| | - Sylvie Gadeyne
- Interface Demography, Department of Sociology, Faculty of Economic and Social Sciences and Solvay Business School; Vrije Universiteit Brussel; Brussels Belgium
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Di Salvo F, Caranci N, Spadea T, Zengarini N, Minicozzi P, Amash H, Fusco M, Stracci F, Falcini F, Cirilli C, Candela G, Cusimano R, Tumino R, Sant M. Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care. Oncotarget 2017; 8:68402-68414. [PMID: 28978126 PMCID: PMC5620266 DOI: 10.18632/oncotarget.19447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/26/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Socioeconomic factors influence access to cancer care and survival. This study investigated the role of socioeconomic status on the risk of breast cancer recurrence and on the delivery of appropriate cancer care (sentinel lymph node biopsy and breast-conserving surgery plus radiotherapy), by patients' age and hormone receptor status. METHODS 3,462 breast cancer cases diagnosed in 2003-2005 were selected from 7 Italian cancer registries and assigned to a socioeconomic tertile on the basis of the deprivation index of their census tract. Multivariable models were applied to assess the delivery of sentinel lymph node biopsy and of breast-conserving surgery plus radiotherapy within socioeconomic tertiles. RESULTS In the 1,893 women younger than 65 years, the 5-year risk of recurrence was higher in the most deprived group than in the least deprived, but this difference was not significant (16.4% vs. 12.9%, log-rank p=0.08); no difference was seen in women ≥65 years. Among the 2,024 women with hormone receptor-positive cancer, the 5-year risk was significantly higher in the most deprived group than in the least deprived one (13.0% vs. 8.9%, p=0.04); no difference was seen in cases of hormone receptor-negative cancer. The most deprived women were less likely than the least deprived women to receive sentinel lymph node biopsy (adjusted odds ratio (ORa), 0.69; 95% CI, 0.56-0.86) and to undergo breast-conserving surgery plus radiotherapy (ORa=0.66; 95% CI, 0.51-0.86). Conclusions: Socioeconomic inequalities affect the risk of recurrence, among patients with hormone receptor-positive cancer, and the opportunity to receive standard care.
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Affiliation(s)
- Francesca Di Salvo
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicola Caranci
- Agenzia Sanitaria e Sociale Regione Emilia Romagna, Bologna, Italy
| | - Teresa Spadea
- Servizio Sovrazonale di Epidemiologia ASL Torino 3, Grugliasco, Italy
| | - Nicolas Zengarini
- Servizio Sovrazonale di Epidemiologia ASL Torino 3, Grugliasco, Italy
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Hade Amash
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mario Fusco
- Naples Cancer Registry, ASL Napoli 3 Sud, Brusciano, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health Department, University of Perugia, Perugia, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Claudia Cirilli
- Modena Cancer Registry, Public Health Department AUSL Modena, Modena, Italy
| | - Giuseppina Candela
- Trapani Cancer Registry, Health Prevention Department ASL 9 Trapani, Trapani, Italy
| | - Rosanna Cusimano
- Palermo Cancer Registry, Health Science Department University of Palermo, Palermo, Italy
| | - Rosario Tumino
- Ragusa Cancer Registry, Health Prevention Department ASP Ragusa, Ragusa, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Neighborhood deprivation and risk of head and neck cancer: A multilevel analysis from France. Oral Oncol 2017; 71:144-149. [DOI: 10.1016/j.oraloncology.2017.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 06/12/2017] [Accepted: 06/17/2017] [Indexed: 01/05/2023]
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Moriceau G, Bourmaud A, Tinquaut F, Oriol M, Jacquin JP, Fournel P, Magné N, Chauvin F. Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study. Oncotarget 2016; 7:1055-65. [PMID: 26540571 PMCID: PMC4808051 DOI: 10.18632/oncotarget.6274] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/30/2015] [Indexed: 12/04/2022] Open
Abstract
Context The European Deprivation Index (EDI), is a new ecological estimate for Socio-Economic Status (SES). This study postulates that Time-To-Treatment could be used as a cancer quality-of -care surrogate in order to identify the association between cancer patient's SES and quality of care in a French comprehensive cancer center. Methods retrospective mono-centered cohort study. All consecutive incoming adult patients diagnosed for breast cancer(BC), prostate cancer(PC), colorectal cancer (CRC), lung cancer(LC) or sarcoma(S) were included between January 2013 and December 2013. The association of EDI and Time-To-Diagnosis(TTD), as well as Time-To-Treatment(TTT) was analyzed using a cox regression, and a strata analysis per tumor site was performed. Results 969 patients were included. Primitive tumor site was 505 BC(52%), 169 PC(17%), 145 LC(15%), 116 CRC(12%), and 34 S(4%). Median TTD was 1.41 months (Q1-Q3 0.5 to 3.5 months). Median TTT was 0.9 months (0.4 - 1.4). In a multivariate analysis, we identified the tumor site as a predictive factor to influence TTD, shorter for BC (0.75months, [0.30- 1.9]) than PC (4.69 months [1.6-29.7]), HR 0.27 95%CI= [0.22-0.34], p < 0.001. TTT was also shorter for BC (0.75months [0.4-1.1]) than PC (2.02 [0.9-3.2]), HR 0.32 95%CI= [0.27-0.39], p < 0.001. EDI quintiles were not found associated with either TTT or TTD. Conclusions Deprivation estimated by the EDI does not appear to be related to an extension of the Time-to-Diagnosis or Time-to-Treatment in our real-life population. Further research should be done to identify other frailty-sensitive factors that could be responsible for delays in care.
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Affiliation(s)
- Guillaume Moriceau
- Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Aurélie Bourmaud
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France
| | - Fabien Tinquaut
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Mathieu Oriol
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | | | - Pierre Fournel
- Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Nicolas Magné
- Radiation Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Franck Chauvin
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France.,Clinical Investigation Center and Clinical Epidemiology, Jean Monnet University, Saint-Etienne, France
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Effects of individual and neighborhood socioeconomic status on the risk of all-cause mortality in chronic obstructive pulmonary disease: A nationwide population-based cohort study, 2002-2013. Respir Med 2016; 114:9-17. [PMID: 27109806 DOI: 10.1016/j.rmed.2016.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 02/05/2016] [Accepted: 03/08/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous previous studies have shown that individual socioeconomic status (SES) is associated with mortality in patients with chronic obstructive pulmonary disease (COPD), but few empirical studies have evaluated the effects of individual SES and neighborhood deprivation on mortality in COPD patients. METHODS We performed a prospective cohort study to examine the effect of socioeconomic disparity on all-cause mortality in newly diagnosed COPD patients in a setting with universal health care coverage. We used representative population-based nationwide cohort data from the Korean National Health Insurance claims database (2002-2013). We included patients who were at least 40 years old and newly diagnosed with COPD (N = 9275). To analyze the data, we utilized a frailty model and Cox's proportional hazard regression. RESULTS A total of 1849 (19.9%) of the 9275 eligible participants died during the study period. Compared to high-income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for middle-income COPD patients who lived in advantaged and disadvantaged neighborhoods was 1.22 (95% CI, 1.03-1.43) and 1.36 (95% CI, 1.15-1.60), respectively. For low-income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than for patients who lived in advantaged neighborhoods (HR, 1.43; 95% CI, 1.17-1.74 vs. HR, 1.36; 95% CI, 1.11-1.66). There was no difference in the adjusted HRs for high-income patients who lived in advantaged and disadvantaged neighborhoods (HR, 1.01; 95% CI, 0.84-1.22). CONCLUSIONS Socioeconomic disparity contributes to all-cause mortality in COPD patients and neighborhood deprivation exacerbates the effect of individual SES on all-cause mortality in COPD patients.
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Cho KH, Lee SG, Nam CM, Lee EJ, Jang SY, Lee SH, Park EC. Disparities in socioeconomic status and neighborhood characteristics affect all-cause mortality in patients with newly diagnosed hypertension in Korea: a nationwide cohort study, 2002-2013. Int J Equity Health 2016; 15:3. [PMID: 26743664 PMCID: PMC4705749 DOI: 10.1186/s12939-015-0288-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 12/15/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Previous studies have shown that contextual factors and individual socioeconomic status (SES) were associated with mortality in Western developed countries. In Korea, there are few empirical studies that have evaluated the association between SES and health outcomes. METHODS We conducted cohort study to investigate the socioeconomic disparity in all-cause mortality for patients newly diagnosed with hypertension in the setting of universal health care coverage. We used stratified random sample of Korean National Health Insurance enrollees (2002-2013). We included patients newly diagnosed with hypertension (n = 28,306) from 2003-2006, who received oral medication to control their hypertension. We generated a frailty model using Cox's proportional hazard regression to assess risk factors for mortality. RESULTS A total of 7,825 (27.6%) of the 28,306 eligible subjects died during the study period. Compared to high income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for high income patients from disadvantaged neighborhoods was 1.10 (95% CI, 1.00-1.20; p-value = 0.05). The adjusted HR for middle income patients who lived in advantaged versus disadvantaged neighborhoods was 1.17 (95% CI, 1.08-1.26) and 1.27 (95% CI, 1.17-1.38), respectively. For low income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than those who lived in advantaged neighborhoods (HR, 1.35; 95% CI, 1.22-1.49 vs HR, 1.28; 95% CI, 1.16-1.41). CONCLUSIONS Neighborhood deprivation can exacerbate the influence of individual SES on all-cause mortality among patients with newly diagnosed hypertension.
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Affiliation(s)
- Kyoung Hee Cho
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea
| | - Sang Gyu Lee
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Chung Mo Nam
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea
- Department of Biostatistics, College of Medicine, Yonsei University, Seoul, Korea
| | - Eun Jung Lee
- Graduate School of Social Welfare, Yonsei University, Seoul, Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea
| | - Seon-Heui Lee
- Department of Nursing Science, College of Nursing, Gachon University, Seongnam, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea.
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul, Korea.
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
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Li S, Li X, Zhao H, Gao M, Wang F, Li W. Overexpression of microRNA‑125a‑3p effectively inhibits the cell growth and invasion of lung cancer cells by regulating the mouse double minute 2 homolog/p53 signaling pathway. Mol Med Rep 2015; 12:5482-6. [PMID: 26151241 DOI: 10.3892/mmr.2015.4038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 01/29/2015] [Indexed: 11/05/2022] Open
Abstract
MicroRNAs (miRs) are a family of small non-coding RNAs that are 21‑24 nucleotides in length. Decreased expression of hsa‑miR‑125a‑3p is observed in a number of patients with non‑small cell lung cancer; however, it is not clear how this miRNA regulates the growth and invasion of lung tumor cells. The aim of the present study was to identify the function of hsa‑miR‑125a‑3p in the growth and invasion of lung cancer cells. The expression of hsa‑miR‑125a‑3p in the A549, NCI‑H460 and SPCA‑1 lung cancer cell lines was analyzed by reverse transcription‑quantitative polymerase chain reaction and the human bronchiolar epithelium cell line (HBE) was used as a control. The results demonstrated that the expression of hsa‑miR‑125a‑3p was significantly lower in NCI‑H460, A549 and SPCA‑1 cells, compared with that in HBE cells. Overexpression of sense miR‑125a‑3p in the A549 lung cancer cell line inhibited cell proliferation for 5‑7 days (P<0.01), and transfection of antisense miR‑125a‑3p did not suppress the cell growth of the lung cancer cells. In addition, overexpression of miR‑125a‑3p in the NCI‑H460 lung cancer cell line markedly induced cell apoptosis, which was detected by fluorescence‑activated cell sorting with annexin V‑fluorescein isothiocyanate/propidium iodide staining. The results of the Transwell migration assay also revealed that transfection of miR‑125a‑3p resulted in decreased migration of lung cancer tumor cells. The pro‑apoptotic gene p53 expression was detected by western blot analysis. The results revealed that the expression of mouse double minute (MDM)‑2 homolog, the principal cellular antagonist of p53, was decreased and p53 expression was upregulated in sense has‑miR‑125a‑3p transfected A549 cells. This was consistent with that observed in NCI‑H460 cells, suggesting that hsa‑miR‑125a‑3p may be involved in the regulation of the MDM2/p53 signaling pathway in lung cancer cells. In conclusion, overexpression of hsa‑miR‑125a‑3p significantly inhibited the proliferation and invasion of lung cancer cells, which may aid in determining the mechanisms underlying the development of lung cancer.
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Affiliation(s)
- Shenglei Li
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Huasi Zhao
- Department of Respiratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Ming Gao
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Feng Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Wencai Li
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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