title: US trends in survival disparities among adolescents and young adults with non-Hodgkin lymphoma.
abstract: OBJECTIVE
  Improvement in US survival rates among adolescents and young adults (AYAs, ages 15 through 39 years inclusive) diagnosed with non-Hodgkin lymphoma (NHL) has been documented over the last two decades. We examined national trends in survival disparities for AYAs with NHL by race/ethnicity and socioeconomic status (SES, county-level poverty) to further understand NHL and to begin monitoring health outcome disparities for this disease.
  
  
  METHODS
  Surveillance Epidemiology and End Results data were used to calculate 5-year relative survival rates of AYAs diagnosed with NHL from 1992 to 2007 and followed through 2011. Absolute and relative disparities were computed using HD*Calc. Whether a significant linear trend was present was evaluated using Joinpoint. Analyses were replicated after excluding individuals with known HIV infection.
  
  
  RESULTS
  The study sample included 9,573 total and 7,121 non-HIV cases of NHL. Five-year survival rates improved for all groups over time. Significant decreases were found in absolute disparities for race/ethnicity (non-HIV), in relative disparities for SES (total) and race/ethnicity (total and non-HIV) (all p < 0.05). Survival rates of non-Hispanic Blacks and Hispanics remained below than those of non-Hispanic Whites throughout the time period.
  
  
  CONCLUSIONS
  Absolute and relative disparities in 5-year survival narrowed for AYAs with NHL over the time period. To continue to promote this trend, future research should investigate factors, particularly diagnostic delays and barriers to care, which continue to contribute to SES and racial/ethnic differences in survival. These factors may be particularly relevant to identify given the recent Affordable Care Act, which is designed to increase access to medical services, particularly for young adults.
authors.affiliation: Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA, Erin.Kent@nih.gov.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Kent
authors.forename: Nancy
authors.initials: N
authors.lastname: Breen
authors.forename: Denise R
authors.initials: DR
authors.lastname: Lewis
authors.forename: Janet S
authors.initials: JS
authors.lastname: de Moor
authors.forename: Ashley Wilder
authors.initials: AW
authors.lastname: Smith
authors.forename: Nita L
authors.initials: NL
authors.lastname: Seibel
mesh_terms: D000293:Adolescent; D000328:Adult; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology; D054624:Health Status Disparities; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology* / Q000208:ethnology*; D008297:Male; D044469:Racial Groups; D012923:Social Class; D014481:United States / Q000453:epidemiology; D055815:Young Adult