Evaluation of Socioeconomic and Racial/Ethnic Disparities in All-Cause Mortality in Adolescents and Young Adults With Cancer
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Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
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Department of Pediatric Hematology/Oncology, Los Angeles Medical Center, Southern California Permanente Medical Group, Los Angeles, CA
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Background: Adolescent and young adult (AYA) patients with cancer have historically been understudied. Few studies have examined survival disparities associated with racial/ethnic and socioeconomic status (SES) and do not account for the influence of insurance status and access to care. We evaluated the association of SES and race/ethnicity with overall mortality for AYA patients who were members of an integrated health system with relatively equal access to care. Methods: AYA patients diagnosed with the 15 most common cancer types during 2010 through 2018 at Kaiser Permanente Southern California were included. Neighborhood Deprivation Index (NDI) quartile (Q1: least deprived; Q4: most deprived) was used as a measure of SES. Mortality rate per 1,000 person-years was calculated for each racial/ethnic and NDI subgroup. Multivariable Cox model was used to estimate hazard ratios (HRs) for all-cause mortality adjusting for sex, age and stage at diagnosis, cancer type, race/ethnicity, and NDI. Results: Data for 6,379 patients were tracked for a maximum of 10 years. Crude mortality rates were higher among non-White racial/ethnic patients compared with non-Hispanic (NH)–White patients. In the Cox model, Hispanic (HR, 1.31; P=.004) and NH-Black (HR, 1.34; P=.05) patients experienced significantly higher all-cause mortality risk compared with NH-White patients. Patients from more deprived neighborhoods had higher mortality risk. In the Cox model, there was no significant difference in all-cause mortality between Q1 and Q2 through Q4 (Q2: HR, 0.88; P=.26, Q3: HR, 0.94; P=.56, and Q4: HR, 0.95; P=.70). Conclusions: For AYAs with cancer with similar access to care, Hispanic and NH-Black patients have higher risk of all-cause mortality than NH-White patients, whereas no significant SES-associated survival disparities were observed. These findings warrant further investigation, awareness, and intervention to address inequities in cancer care among vulnerable populations.
Submitted September 5, 2023; final revision received February 29, 2024; accepted for publication March 19, 2024.
Author contributions: Study design: Henderson, Chao, Cooper. Investigation: Duggan. Writing—original draft: Henderson. Writing—review & editing: Duggan, Chao, Cooper.
Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: Research reported in this publication was supported by the Regional Research Committee Kaiser Permanente Southern California (KP-RRC-20191004; R. Cooper).
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