Differences in marital status and mortality by race/ethnicity and nativity among California cancer patients

Abstract

Background It has been observed that married cancer patients have lower mortality rates than unmarried patients, but data for different racial/ethnic groups are scarce. The authors examined the risk of overall mortality associated with marital status across racial/ethnic groups and sex in data from the California Cancer Registry. Methods California Cancer Registry data for all first primary invasive cancers diagnosed from 2000 through 2009 for the 10 most common sites of cancer-related death for non-Hispanic whites (NHWs), blacks, Asians/Pacific Islanders (APIs), and Hispanics were used to estimate multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) for marital status in relation to overall mortality by race/ethnicity and sex. The study cohort included 393,470 male and 389,697 female cancer patients and 204,007 and 182,600 deaths from all causes, respectively, through December 31, 2012. Results All-cause mortality was higher in unmarried patients than in married patients, but there was significant variation by race/ethnicity. Adjusted HRs (95% CIs) ranged from 1.24 (95% CI, 1.23-1.26) in NHWs to 1.11 (95% CI, 1.07-1.15) in APIs among males and from 1.17 (95% CI, 1.15-1.18) in NHWs to 1.07 (95% CI, 1.04-1.11) in APIs among females. All-cause mortality associated with unmarried status compared with married status was higher in US-born API and Hispanic men and women relative to their foreign-born counterparts. Conclusions For patients who have the cancers that contribute most to mortality, being unmarried is associated with worse overall survival compared with being married, with up to 24% higher mortality among NHW males but only 6% higher mortality among foreign-born Hispanic and API females. Future research should pursue the identification of factors underlying these associations to inform targeted interventions for unmarried cancer patients.

Incidence and risk factors of gastrointestinal neuroendocrine neoplasm metastasis in liver, lung, bone, and brain: A population‐based study

“…Increasing tumor size, T stage and N stage, was related to the higher risk of NEN metastasis. Insurance and marital status had no influence on the metastasis of GI‐NENs to the liver, lung, bone and brain in the current study, although earlier reports showed that insured patients might receive more early examination and married patients tend to undergo earlier testing and receive more adequate treatment …”

Incidence, Survival, and Risk Factors for Adults with Acute Myeloid Leukemia Not Otherwise Specified and Acute Myeloid Leukemia with Recurrent Genetic Abnormalities: Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database, 2001–2013

“…Single patients are thought to have less support – emotionally, physically, or financially – and make different lifestyle choices, and these differences have an impact on their ability to survive a diagnosis of cancer [38]. Race or ethnicity may have some influence of the degree of risk for single patients, as Martinez et al [35] found that the risk of death due to cancer was greater for nonmarried white patients than for nonmarried black, Hispanic, or Asian/Pacific Islander patients. All of these issues should be examined in detail to find ways to help single patients experience better outcomes.…”

The incidence, risk factors, and survival of acute myeloid leukemia secondary to myelodysplastic syndrome: A population‐based study

“…Although the effect may not be as large as that of clinical factors, such as the histological type, our findings are supported by a growing body of knowledge that social and demographic factors, such as the marital status, can influence the survival of patients with cancer. Over the past 10 years, studies by multiple groups have revealed that the survival of married patients is significantly better than that of nonmarried patients for several types of cancer . Because the population we assessed was more than 80% White, the effect of marital status could be race‐specific.…”

“…Because the population we assessed was more than 80% White, the effect of marital status could be race‐specific. Recent studies by Martinez et al support this idea, because these authors found that race had a significant influence on the effect of marital status on all‐cause and cancer‐specific mortality among 800 000 patients in the California Cancer Registry (CCR) . The most viable explanations for the effect of marriage on survival are that married patients have more support (emotionally, physically, or financially) or are less likely to make lifestyle choices that are detrimental to their health .…”