Impact of socioeconomic status on survival of colorectal cancer patients

Zhang, Qian; Wang, Yufu; Hu, Hanqing; Huang, Rui; Xie, Lei; Liu, Enrui; Chen, Yinggang; Wang, Guiyu; Wang, Xishan

doi:10.18632/oncotarget.20859

Cited by 22 publications

(25 citation statements)

References 27 publications

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“…In 2013, a large population-based study showed that married patients were at low risk to present with metastatic disease and more likely to receive effective treatment, as compared to the unmarried patients who faced a significantly higher risk of mortality with colon cancer [ 6 ]. A similar conclusion was obtained in three studies [ 5 , 9 , 15 ], and another previous study found that marriage could result in improved cardiovascular, endocrine, and immune function [ 16 ]. We also believed that the depression caused by not being married was related to Vascular Endothelial Growth Factor (VEGF), which could stimulate endothelial cell migration, proliferation and proteolytic activity [ 17 ].…”

Section: Discussionsupporting

confidence: 88%

“…We also believed that the depression caused by not being married was related to Vascular Endothelial Growth Factor (VEGF), which could stimulate endothelial cell migration, proliferation and proteolytic activity [ 17 ]. Reportedly, Medicaid status or no insurance was associated with unfavorable survival [ 7 , 8 , 15 ]. We held the view that the following three reasons might lead to the poor prognosis of Medicaid status: Medicaid beneficiaries are initiating treatment late, or receiving inadequate treatment; adults enrolled in the Medicaid program are likely to be disabled, presenting with psychiatric and/or physical comorbidities; and these patients would encounter various barriers (e.g., transportation, poor psychosocial support) that may hinder receipt of adequate treatment and follow-up care [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Real-World Implications of Nonbiological Factors with Staging, Prognosis and Clinical Management in Colon Cancer

Liu

Luo

Cai

et al. 2018

Cancers

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Background: The present study analyzed the nonbiological factors (NBFs) together with the American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) staging system to generate a refined, risk-adapted stage for the clinical treatment of colon cancer. Methods: Eligible patients (N = 28,818) with colon cancer between 1 January 2010 and 31 December 2014, were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier curves and Cox proportional hazards regression, analyzed the probabilities of cancer-specific survival (CSS) in patients with colon cancer, with different NBF-TNM stages. Results: Insurance status, marital status, and median household income were significant prognostic NBFs in the current study (p < 0.05). The concordance index of NBF-TNM stage was 0.857 (95% confidence interval (CI) = 0.8472–0.8668). Multivariate Cox analyses, indicated that NBF1-stage was independently associated with a 50.4% increased risk of cancer-specific mortality in colon cancer (p < 0.001), which increased to 77.1% in non-metastatic colon cancer. NBF0-stage improved in CSS as compared to the NBF1-stage in the respective stages (p < 0.05). Conclusions: The new proposed NBF-stage was an independent prognostic factor in colon cancer. Effect of NBFs on the survival of colon cancer necessitates further clinical attention. Moreover, the incorporation of NBF-stage into the AJCC TNM staging system is essential for prognostic prediction, and clinical guidance of adjuvant chemotherapy in stage II and III colon cancer.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Real-World Implications of Nonbiological Factors with Staging, Prognosis and Clinical Management in Colon Cancer

Liu

Luo

Cai

et al. 2018

Cancers

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“…Previous studies have shown racial and socioeconomic disparities in CRC incidence, stage at diagnosis, and cancer related mortality (9–11). Since 1960, CRC mortality has declined by 39% among whites, but increased by 28% among blacks (12).…”

Section: Discussionmentioning

confidence: 99%

Disparities in Emergent Colectomy for Colorectal Cancer Contribute to Inequalities in Postoperative Morbidity and Mortality in The US Health Care System

et al. 2019

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Background and Aims: Colorectal cancer is the third most common cancer among both men and women in the United States. We aimed to determine racial and socioeconomic disparities in emergent colectomy rates for colorectal cancer in the US Health Care system. Material and Methods: We performed a retrospective analysis of the National Inpatient Sample including adult patients (⩾18 years) diagnosed with colorectal cancer, and who underwent colorectal resection while admitted between 2008 and 2015. Multivariable logistic and linear regression were used to assess the association between emergent admissions, compared to elective admissions, and postoperative outcomes. Results: A total of 141,641 hospitalizations were included: 93,775 (66%) were elective admissions and 47,866 (34%) were emergent admissions. Black patients were more likely to undergo emergent colectomy, compared to white patients (42% vs 32%, p < 0.0001). Medicaid and Medicare patients were also more likely to have an emergent colectomy, compared to private insurance (47% and 36% vs 25%, respectively, p < 0.0001), as were patients with low household income, compared to highest (38% vs 31%, p < 0.0001). Emergent procedures were less likely to be laparoscopic (19% vs 38%, p < 0.0001). Patients undergoing emergent colectomy were significantly more likely to have postoperative venous thromboembolism, wound complications, infection, bleeding, cardiac failure, renal failure, respiratory failure, shock, and inpatient mortality. Conclusion: There are significant racial and socioeconomic disparities in emergent colectomy rates for colorectal cancer. Efforts to reduce this disparity in colorectal cancer surgery patients should be prioritized to improve outcomes.

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“…Modifiable and non-modifiable risk factors, including age, genetics, sedentary lifestyle, and socioeconomic status (SES) have been known to affect CRC development (7,(14)(15)(16). Several studies have examined differences in CRC incidence, mortality, and survival by these factors (12,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). Zhang et al (31) used the Surveillance, Epidemiology, and End Results (SEER) data from 2007 to 2013 to investigate the impact of SES on overall CRC survival.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have examined differences in CRC incidence, mortality, and survival by these factors ( 12 , 16 – 31 ). Zhang et al ( 31 ) used the Surveillance, Epidemiology, and End Results (SEER) data from 2007 to 2013 to investigate the impact of SES on overall CRC survival. Results revealed that patients with CRC who were non-Hispanic Black, widowed, on Medicaid, and with the lowest education had relatively poor prognoses.…”

Section: Introductionmentioning

confidence: 99%

A National Study of Colorectal Cancer Survivorship Disparities: A Latent Class Analysis Using SEER (Surveillance, Epidemiology, and End Results) Registries

Ishino

Odame

Villalobos

et al. 2021

Front. Public Health

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Introduction: Long–standing disparities in colorectal cancer (CRC) outcomes and survival between Whites and Blacks have been observed. A person–centered approach using latent class analysis (LCA) is a novel methodology to assess and address CRC health disparities. LCA can overcome statistical challenges from subgroup analyses that would normally impede variable–centered analyses like regression. Aim was to identify risk profiles and differences in malignant CRC survivorship outcomes.Methods: We conducted an LCA on the Surveillance, Epidemiology, and End Results data from 1975 to 2016 for adults ≥18 (N = 525,245). Sociodemographics used were age, sex/gender, marital status, race, and ethnicity (Hispanic/Latinos) and stage at diagnosis. To select the best fitting model, we employed a comparative approach comparing sample-size adjusted BIC and entropy; which indicates a good separation of classes.Results: A four–class solution with an entropy of 0.72 was identified as: lowest survivorship, medium-low, medium-high, and highest survivorship. The lowest survivorship class (26% of sample) with a mean survival rate of 53 months had the highest conditional probabilities of being 76–85 years–old at diagnosis, female, widowed, and non-Hispanic White, with a high likelihood with localized staging. The highest survivorship class (53% of sample) with a mean survival rate of 92 months had the highest likelihood of being married, male with localized staging, and a high likelihood of being non-Hispanic White.Conclusion: The use of a person–centered measure with population-based cancer registries data can help better detect cancer risk subgroups that may otherwise be overlooked.

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Impact of socioeconomic status on survival of colorectal cancer patients

Cited by 22 publications

References 27 publications

Real-World Implications of Nonbiological Factors with Staging, Prognosis and Clinical Management in Colon Cancer

Real-World Implications of Nonbiological Factors with Staging, Prognosis and Clinical Management in Colon Cancer

Disparities in Emergent Colectomy for Colorectal Cancer Contribute to Inequalities in Postoperative Morbidity and Mortality in The US Health Care System

A National Study of Colorectal Cancer Survivorship Disparities: A Latent Class Analysis Using SEER (Surveillance, Epidemiology, and End Results) Registries

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