title: Multilevel socioeconomic effects on quality of life in adolescent and young adult survivors of leukemia and lymphoma.
abstract: OBJECTIVE
  Cancer registry survival analyses have shown that adolescent and young adult patients with low socioeconomic status (SES) have reduced survival compared to those with higher SES. The objective of this study was to determine whether neighborhood- (nSES) and/or individual-level SES (iSES) also predicted current quality of life in adolescent and young adult survivors.
  
  
  METHODS
  The Socioeconomics and Quality of Life study surveyed adolescent and young adult survivors of leukemia and lymphoma at least one year post-diagnosis using population-based ascertainment. Factor analysis was used to create a multidimensional age-relevant iSES score and compared with a preexisting census-block-group derived nSES score. Four quality of life domains were assessed: physical health, psychological and emotional well-being, social relationships, and life skills. Nested multivariable linear regression models were run to test the associations between both SES measures and quality of life and to compare the explanatory power of nSES and iSES.
  
  
  RESULTS
  Data from 110 individuals aged 16-40 were included in the final analysis. After adjustment for sociodemographic confounders, low nSES was associated only with poorer physical health, whereas low iSES was related to poorer quality of life in all four domains with iSES accounting for an additional 14, 12, 25, and 10 % of the variance, respectively.
  
  
  CONCLUSIONS
  Measures of SES at the individual as compared to the neighborhood level may be stronger indicators of outcomes in adolescents and young adults, which has important implications for SES measurement in the context of cancer surveillance.
authors.affiliation: Cancer Prevention Fellowship Program, National Cancer Institute, National Institutes of Health, 6116 Executive Blvd, Bethesda, MD 20892, USA. Erin.Kent@nih.gov
authors.forename: Erin E
authors.initials: EE
authors.lastname: Kent
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Sender
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Morris
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Grigsby
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Montoya
authors.forename: Argyrios
authors.initials: A
authors.lastname: Ziogas
authors.forename: Hoda
authors.initials: H
authors.lastname: Anton-Culver
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D054624:Health Status Disparities; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D007938:Leukemia / Q000523:psychology*; D016015:Logistic Models; D008223:Lymphoma / Q000523:psychology*; D008297:Male; D015999:Multivariate Analysis; D011788:Quality of Life; D012111:Residence Characteristics; D012923:Social Class; D012959:Socioeconomic Factors; D016019:Survival Analysis; D017741:Survivors / Q000523:psychology; D055815:Young Adult