PO.PS01.12 · 人群科学

跨生命周期考量地区层面剥夺程度与新诊断结直肠癌患者生存结局的关联

Associations of area level deprivation with survival outcomes among patients with newly diagnosed colorectal cancer considered across the lifespan

编号 6257 展板 19 时间 4/21 02:00–05:00 区域 Section 33 主讲 Jessica Burns

分会场 Environmental and Occupational Risk Factors, Infection, and Aging

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作者与单位 Authors & Affiliations

Jessica R. Burns¹, Maria F. Gomez², Stephanie Hogue¹, Esther Jean-Baptiste¹, Julaxis Love¹, Erin Siegel², Adetunji T. Toriola³, Christopher I. Li⁴, Jane C. Figueiredo⁵, Nicole C. Loroña⁵, Biljana Gigic⁶, David Shibata⁷, Seth Felder⁸, Patricia A. Erickson⁹, Mmadili N. Ilozumba⁹, Ildiko Strehli⁹, Megan Mclaws⁹, Victoria Damerell⁶, Shaneda Warren Andersen¹⁰, Caroline Himbert⁹, Cornelia M. Ulrich⁹, Sheetal Hardikar⁹, Doratha A. Byrd²

¹Non-Therapeutic Research Office, Moffitt Cancer Center, Tampa, FL,²Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL,³Siteman Cancer Center, Washington University School of Medicine in St. Louis, St. Louis, MO,⁴Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA,⁵Department of Medicine at Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA,⁶Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany,⁷Department of Surgery, University of Tennessee Health Science Center, Memphis, TN,⁸Department of Gastroenterological Oncology, Moffitt Cancer Center, Tampa, FL,⁹Huntsman Cancer Institute, Salt Lake City, UT,¹⁰University of Wisconsin, Madison, WI

摘要 Abstract

中文摘要

背景：结直肠癌（CRC）是美国癌症相关死亡的第二大总体主要病因。地区剥夺指数（ADI）是一种社区社会经济劣势的衡量指标，反映了多种与CRC生存相关的暴露，包括资源、医疗、生活质量以及其他经济流动机会的可及性。这些暴露可能因出生队列而异，因此按发病年龄考察ADI十分重要。本研究的目的是在ColoCare Study中，按发病年龄（早发：<50岁（EO），平均：50-64岁（AO），老年：≥65岁（LO））调查ADI与总生存（OS）和无病生存（DFS）的关联。方法：我们纳入了ColoCare Study的美国数据，这是一项针对新诊断I-IV期CRC患者的前瞻性多中心队列研究。采用研究入组时记录的居住地址计算国家级和州级ADI。我们比较了各发病年龄组的ADI，并采用多变量Cox比例风险模型估算ADI与OS和DFS关联的风险比（HR）和95%置信区间（95% CI），包括总体以及按发病年龄、种族和族裔分层。结果：ColoCare研究中有2,477名参与者具有ADI数据，从诊断日期起至死亡日期、末次随访或第5年删失结束，中位随访时间为3.6年（SD=2.5）。平均而言，LO组的国家级ADI（均值=4.08[2.81]）高于AO组（均值=3.93[2.85]；P<0.001）和早发组（均值=3.49[2.72]；P<0.001）。基于国家百分位数的ADI生存关联往往强于基于州的关联。以国家级ADI每增加10个百分位数计算，LO组和EO组的总死亡风险分别升高8%（95% CI=1.01，1.15；P=0.02）和10%（95% CI=1.01，1.21；P=0.03）。在对种族校正国家级ADI后，LO组和AO组的总死亡风险分别升高6%和3%。在平均发病个体中，ADI指标与OS的关联更接近无效值且无统计学显著性。ADI与DFS的关联在EO组和LO组中较弱且无统计学显著性，但在AO组中ADI与DFS呈正相关（HR_DFS=1.09；1.01-1.16；P=0.02）。尽管无统计学显著性，ADI与OS和DFS的关联在非西班牙裔黑人个体中最强（HR_OS=1.12；95% CI=0.92，1.36；P=0.27；HR_DFS=1.14；0.93-1.40；P=0.20）。结论：我们观察到年长的CRC生存者往往居住在更为剥夺的地区；然而，跨生命周期来看，地区层面的健康决定因素与更差的CRC生存结局相关。

查看英文原文 English abstract

Background: Colorectal cancer (CRC) is the second overall leading cause of cancer-related deaths in the United States (US). The Area Deprivation Index (ADI), a neighborhood socioeconomic disadvantage measure, reflects multiple CRC survival-related exposures including access to resources, healthcare, quality of life, and other opportunities for economic mobility. These exposures may vary by birth cohort, making it important to examine ADI across age of onset. The purpose of this study is to investigate the associations of ADI with overall (OS) and disease-free survival (DFS) by age of onset (early: <50 years (EO), average: 50-64 years (AO), older: ≥65 years (LO)) in the ColoCare Study. Methods: We included US data from the ColoCare Study, a prospective multicenter cohort study of newly diagnosed stage I-IV CRC patients. National- and state-level ADI were calculated using residential addresses captured at study entry. We compared ADI across ages of onset and estimated hazard ratios (HRs) and 95% confidence intervals (95% CI) for the associations of ADI with OS and DFS using multivariable Cox proportional hazard models, overall and stratified by age of onset, race, and ethnicity. Results: There were 2,477 participants from the ColoCare study with ADI data, with a median follow-up time of 3.6 years (SD=2.5) starting at the date of diagnosis and ending at the date of death, last follow-up, or censored at 5 years. On average, individuals in the LO group had higher national ADI (mean=4.08 [2.81]) compared to the AO group (mean=3.93 [2.85]; P<0.001) and early onset group (mean=3.49 [2.72]; P<0.001]). Survival associations of the ADI based on national percentiles tended to be stronger than those based on the state. Considered per 10-percentile increase in national-level ADI, there was an 8% (95% CI=1.01, 1.15; P=0.02) and 10% (95% CI= 1.01, 1.21; P=0.03) higher overall mortality risk among LO and EO groups, respectively. After adjusting national-level ADI for race, there was a 6% and 3% higher overall mortality risk among the LO and AO groups, respectively. Among average onset individuals, the association of the ADI measures with OS was closer to the null and not statistically significant. Associations of ADI with DFS were weaker and not statistically significant among the EO and LO groups, but the ADI was positively associated with DFS among the AO groups (HR DFS =1.09; 1.01-1.16; P=0.02). Though not statistically significant, the associations of ADI with OS and DFS were strongest among Non-Hispanic Black individuals (HR OS = 1.12; 95% CI=0.92, 1.36; P=0.27; and HR DFS =1.14; 0.93-1.40; P=0.20). Conclusion: We observed that older CRC survivors tended to live in more deprived areas; however, across the lifespan, area level determinants of health were associated with poorer CRC survival outcomes.

利益披露 Disclosure

J. R. Burns, None.. M. F. Gomez, None.. S. Hogue, None.. E. Jean-Baptiste, None.. J. Love, None.. E. Siegel, None.. A. T. Toriola, None.. C. I. Li, None.. J. C. Figueiredo, None.. N. C. Loroña, None.. B. Gigic, None.. D. Shibata, None.. S. Felder, None.. P. A. Erickson, None.. M. N. Ilozumba, None.. I. Strehli, None.. M. Mclaws, None.. V. Damerell, None.. S. Warren Andersen, None.. C. Himbert, None.. C. M. Ulrich, None.. S. Hardikar, None.. D. A. Byrd, None.

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