Effects of marital status and economic resources on survival after cancer: A population‐based study

Abstract

BACKGROUND Although married cancer patients have more favorable survival than unmarried patients, reasons underlying this association are not fully understood. The authors evaluated the role of economic resources, including health insurance status and neighborhood socioeconomic status (nSES), in a large California cohort. METHODS From the California Cancer Registry, we identified 783,167 cancer patients (386,607 deaths) who were diagnosed during 2000 through 2009 with a first primary, invasive cancer of the 10 most common sites of cancer-related death for each sex and were followed through 2012. Age-stratified and stage-stratified Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for all-cause mortality associated with marital status, adjusted for cancer site, race/ethnicity, and treatment. RESULTS Compared with married patients, unmarried patients had an elevated risk of mortality that was higher among males (HR, 1.27; 95% CI, 1.26–1.29) than among females (HR, 1.19; 95% CI, 1.18–1.20; Pinteraction < .001). Adjustment for insurance status and nSES reduced the marital status HRs to 1.22 for males and 1.15 for females. There was some evidence of synergistic effects of marital status, insurance, and nSES, with relatively higher risks observed for unmarried status among those who were under-insured and living in high nSES areas compared with those who were under-insured and living in low nSES areas (Pinteraction = 6.8 × 10−9 among males and 8.2 × 10−8 among females). CONCLUSIONS The worse survival of unmarried than married cancer patients appears to be minimally explained by differences in economic resources.

Association between socioeconomic factors at diagnosis and survival in breast cancer: A population‐based study

“…Unlike other causes of death, the morbidity and mortality of breast cancer show positive correlations with socioeconomic factors and vary substantially across countries and, with each county, are associated with the economic development, social factors, and lifestyles . A large number of population‐based retrospective studies have been conducted in many areas aimed to explore the association between breast cancer survival and socioeconomic factors .…”

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

“…Prior analyses of these data 19 indicated significant differences in mortality by sex; therefore, all analyses presented here were conducted separately for males and females. Consistent with a recent review of mortality and marital status indicating that mortality risks did not vary across subcategories of unmarried status, 20 we conducted analyses using marital status coded as married and unmarried (never married, separated, divorced, and widowed).…”

Single Marital Status and Infectious Mortality in Women With Cervical Cancer in the United States

“…7,19 According to previous studies, unmarried status was associated with poorer prognosis compared with married status, and this is particularly evident in women with gynecological malignancies. 20,21 However, little is known about the effect of marital status and survival in women with cervical cancer in the United States.…”