title: Impact of Treatment and Insurance on Socioeconomic Disparities in Survival after Adolescent and Young Adult Hodgkin Lymphoma: A Population-Based Study.
abstract: BACKGROUND
  Previous studies documented racial/ethnic and socioeconomic disparities in survival after Hodgkin lymphoma among adolescents and young adults (AYA), but did not consider the influence of combined-modality treatment and health insurance.
  
  
  METHODS
  Data for 9,353 AYA patients ages 15 to 39 years when diagnosed with Hodgkin lymphoma during 1988 to 2011 were obtained from the California Cancer Registry. Using multivariate Cox proportional hazards regression, we examined the impact of sociodemographic characteristics [race/ethnicity, neighborhood socioeconomic status (SES), and health insurance], initial combined-modality treatment, and subsequent cancers on survival.
  
  
  RESULTS
  Over the 24-year study period, we observed improvements in Hodgkin lymphoma-specific survival by diagnostic period and differences in survival by race/ethnicity, neighborhood SES, and health insurance for a subset of more recently diagnosed patients (2001-2011). In multivariable analyses, Hodgkin lymphoma-specific survival was worse for Blacks than Whites with early-stage [HR: 1.68; 95% confidence interval (CI): 1.14-2.49] and late-stage disease (HR: 1.68; 95% CI, 1.17-2.41) and for Hispanics than Whites with late-stage disease (HR: 1.58; 95% CI, 1.22-2.04). AYAs diagnosed with early-stage disease experienced worse survival if they also resided in lower SES neighborhoods (HR: 2.06; 95% CI, 1.59-2.68). Furthermore, more recently diagnosed AYAs with public health insurance or who were uninsured experienced worse Hodgkin lymphoma-specific survival (HR: 2.08; 95% CI, 1.52-2.84).
  
  
  CONCLUSIONS
  Our findings identify several subgroups of Hodgkin lymphoma patients at higher risk for Hodgkin lymphoma mortality.
  
  
  CONCLUSIONS
  Identifying and reducing barriers to recommended treatment and surveillance in these AYAs at much higher risk of mortality is essential to ameliorating these survival disparities.
authors.affiliation: Division of Hematology and Oncology, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, California. tkeegan@ucdavis.edu.
authors.forename: Theresa H M
authors.initials: TH
authors.lastname: Keegan
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.
authors.forename: Mindy C
authors.initials: MC
authors.lastname: DeRouen
authors.affiliation: Department of Epidemiology and Biostatistics, The University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Helen M
authors.initials: HM
authors.lastname: Parsons
authors.affiliation: Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Clarke
authors.affiliation: Cancer Prevention Institute of California, Fremont, California.
authors.forename: Debbie
authors.initials: D
authors.lastname: Goldberg
authors.affiliation: Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
authors.affiliation: Cancer Prevention Institute of California, Fremont, California. Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, Stanford, California.
authors.forename: Sally L
authors.initials: SL
authors.lastname: Glaser
mesh_terms: D000293:Adolescent; D000328:Adult; D054624:Health Status Disparities; D006689:Hodgkin Disease / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D012042:Registries; D012923:Social Class; D015996:Survival Rate; D055815:Young Adult
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