Factors Associated With Cancer Disparities Among Low-, Medium-, and High-Income US Counties

O’Connor, Joanne; Sedghi, Tannaz; Dhodapkar, Meera; Kane, Michael J.; Gross, Cary P.

doi:10.1001/jamanetworkopen.2018.3146

Cited by 83 publications

(59 citation statements)

References 51 publications

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“…In this paper we used a Oaxaca-Blinder approach to study the determinants of the disparities between apprentices and high school students in regards to daily smoking. It is important to highlight that there are different techniques that could be used to decompose the disparity between 2 groups including mediation analysis [52][53][54]. Yet, it has been shown that OBD and mediation analyses provide similar conclusions with similar causal assumptions [55].…”

Section: Discussionmentioning

confidence: 99%

Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis

et al. 2020

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Background: Educational disparities in daily smoking begin during adolescence and can lead to educational disparities in health among adults. In particular, vocational students including apprentices have higher daily smoking rates compared to non-vocational students. This study aimed to identify the determinants of the gap in daily smoking between French apprentices and high school students aged 17 in 2008 and in 2017. Methods: We used data from a cross-sectional repeated survey representative of all French adolescents aged 17 in 2008 and 2017. We conducted a non-linear extension of the Oaxaca-Blinder decomposition technique and included the following variables: sociodemographic and familial characteristics, parental smoking, cannabis and alcohol use, suicidal attempt, grade repetition and money received. Results: Daily smoking was about two times higher among French apprentices compared to high school students in 2008. This gap did not decrease between 2008 and 2017. Differences in measured characteristics between the two groups explained this gap partly, from 28.6 to 51.2%. Cannabis and alcohol use, money received and parental smoking contributed the most to the daily smoking gap. Conclusions: Prevention programs could target cannabis and alcohol use as well as parental smoking to help decrease educational disparities in smoking status among French adolescents.

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Section: Discussionmentioning

confidence: 99%

Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis

et al. 2020

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“…26 We found that brain tumor craniotomy SNH patients were more likely to be non-white, uninsured, and low income ( Table 3 ), which are factors that earlier studies have correlated with decreased access, adverse discharge disposition, and excess mortality. 2 , 5 , 27 Poorer outcomes in vulnerable patients may be attributed to higher rates of comorbidities and barriers like health literacy, social support, and access to preventive care. The greater frequency of patients in our study population from the highest income quartile (29.0%), compared to the lowest (20.3%), may reflect the impaired medical access and shorter overall life expectancies documented in low-income geographies.…”

Section: Discussionmentioning

confidence: 99%

The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis

Tang

Perla

Lim

et al. 2020

Neuro-Oncology Advances

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Background Outcome disparities have been documented at safety-net hospitals (SNHs), which disproportionately serve vulnerable patient populations. Using a nationwide retrospective cohort, we assessed inpatient outcomes following brain tumor craniotomy at SNHs in the United States. Methods We identified all craniotomy procedures in the National Inpatient Sample from 2002-2011 for brain tumors: glioma, metastasis, meningioma, and vestibular schwannoma. Safety-net burden was calculated as the number of Medicaid plus uninsured admissions divided by total admissions. Hospitals in the top quartile of burden were defined as SNHs. The association between SNH status and in-hospital mortality, discharge disposition, complications, hospital-acquired conditions (HACs), length of stay (LOS), and costs were assessed. Multivariate regression adjusted for patient, hospital, and severity characteristics. Results 304,719 admissions were analyzed. The most common subtype was glioma (43.8%). Of 1,206 unique hospitals, 242 were SNHs. SNH admissions were more likely to be non-white (P<0.001), low-income (P<0.001), and have higher severity scores (P=0.034). Mortality rates were higher at SNHs for metastasis admissions (odds ratio [OR]=1.48, P=0.025), and SNHs had higher complication rates for meningioma (OR=1.34, P=0.003) and all tumor types combined (OR=1.17, P=0.034). However, there were no differences at SNHs for discharge disposition or HACs. LOS and hospital costs were elevated at SNHs for all subtypes, culminating in a 10% and 9% increase in LOS and costs for the overall population, respectively (all P<0.001). Conclusions SNHs demonstrated poorer inpatient outcomes for brain tumor craniotomy. Further analyses of the differences observed and potential interventions to ameliorate interhospital disparities are warranted.

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“…There are wide gaps in cancer death rates among low-income, medium-income and high-income counties. 35 A study by O’Connor et al assessed the relationship between US county income levels across the USA and cancer death rates. The cancer death rate of low-income residents who lived in rural areas was 229.7 per 100 000 person-years in low-income counties, compared with 204.9 and 185.9 per 100 000 person-years in medium-incom and high-income counties, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The cancer death rate of low-income residents who lived in rural areas was 229.7 per 100 000 person-years in low-income counties, compared with 204.9 and 185.9 per 100 000 person-years in medium-incom and high-income counties, respectively. 35 In China, 91.1% of households in rural patients with end-of-life cancer were below the poverty line compared with 84.1% of urban patients. 36 Rural patients with cancer continued to suffer long-term financial burden and increased out-of-pocket expenses.…”

Section: Discussionmentioning

confidence: 99%

Geographical disparities in the prognosis of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: a large institution-based cohort study from an endemic area

et al. 2020

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ObjectivesGeographical disparities have been identified as a specific barrier to cancer screening and a cause of worse outcomes for patients with cancer. In the present study, our aim was to assess the influence of geographical disparities on the survival outcomes of patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiation therapy (IMRT).DesignCohort study.SettingGuangzhou, China.ParticipantsA total of 1002 adult patients with NPC (724 males and 278 females) who were classified by area of residence (rural or urban) received IMRT from 1 January 2010 to 31 December 2014, at Sun Yat-sen University Cancer Center. Following propensity score matching (PSM), 812 patients remained in the analysis.Main outcome measuresWe used PSM to reduce the bias of variables associated with treatment effects and outcome prediction. Survival outcomes were estimated using the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox regression was used to identify independent prognostic factors.ResultsIn the matched cohort, 812 patients remained in the analysis. Kaplan-Meier survival analysis revealed that the rural group was significantly associated with worse overall survival (OS, p<0.001), disease-free survival (DFS, p<0.001), locoregional relapse-free survival (LRRFS, p=0.003) and distant metastasis-free survival (DMFS, p<0.001). Multivariate Cox regression showed worse OS (HR=3.126; 95% CI 1.902 to 5.138; p<0.001), DFS (HR=2.579; 95% CI 1.815 to 3.665; p<0.001), LRRFS (HR=2.742; 95% CI 1.359 to 5.533; p=0.005) and DMFS (HR=2.461; 95% CI 1.574 to 3.850; p<0.001) for patients residing in rural areas.ConclusionsThe survival outcomes of patients with NPC who received the same standardised treatment were significantly better in urban regions than in rural regions. By analysing the geographic disparities in outcomes for NPC, we can guide the formulation of healthcare policies.

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Factors Associated With Cancer Disparities Among Low-, Medium-, and High-Income US Counties

Cited by 83 publications

References 51 publications

Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis

Why do apprentices smoke much more than high school students? Understanding educational disparities in smoking with a Oaxaca-blinder decomposition analysis

The impact of hospital safety-net status on inpatient outcomes for brain tumor craniotomy: a 10-year nationwide analysis

Geographical disparities in the prognosis of patients with nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: a large institution-based cohort study from an endemic area

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