title: Individual- and neighborhood-level predictors of mortality in Florida colorectal cancer patients.
abstract: OBJECTIVE
  We examined individual-level and neighborhood-level predictors of mortality in CRC patients diagnosed in Florida to identify high-risk groups for targeted interventions.
  
  
  METHODS
  Demographic and clinical data from the Florida Cancer Data System registry (2007-2011) were linked with Agency for Health Care Administration and US Census data (n = 47,872). Cox hazard regression models were fitted with candidate predictors of CRC survival and stratified by age group (18-49, 50-64, 65+).
  
  
  RESULTS
  Stratified by age group, higher mortality risk per comorbidity was found among youngest (21%), followed by middle (19%), and then oldest (14%) age groups. The two younger age groups had higher mortality risk with proximal compared to those with distal cancer. Compared with private insurance, those in the middle age group were at higher death risk if not insured (HR = 1.35), or received healthcare through Medicare (HR = 1.44), Medicaid (HR = 1.53), or the Veteran's Administration (HR = 1.26). Only Medicaid in the youngest (52% higher risk) and those not insured in the oldest group (24% lower risk) were significantly different from their privately insured counterparts. Among 18-49 and 50-64 age groups there was a higher mortality risk among the lowest SES (1.17- and 1.23-fold higher in the middle age and 1.12- and 1.17-fold higher in the older age group, respectively) compared to highest SES. Married patients were significantly better off than divorced/separated (HR = 1.22), single (HR = 1.29), or widowed (HR = 1.19) patients.
  
  
  CONCLUSIONS
  Factors associated with increased risk for mortality among individuals with CRC included being older, uninsured, unmarried, more comorbidities, living in lower SES neighborhoods, and diagnosed at later disease stage. Higher risk among younger patients was attributed to proximal cancer site, Medicaid, and distant disease; however, lower SES and being unmarried were not risk factors in this age group. Targeted interventions to improve survivorship and greater social support while considering age classification may assist these high-risk groups.
authors.affiliation: Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Tannenbaum
authors.affiliation: Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
authors.forename: Monique
authors.initials: M
authors.lastname: Hernandez
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
authors.forename: D Dandan
authors.initials: DD
authors.lastname: Zheng
authors.affiliation: Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Sussman
authors.affiliation: Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida, United States of America; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America.
authors.forename: David J
authors.initials: DJ
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology*; D015897:Comorbidity; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult