Individual- and neighborhood-level predictors of mortality in Florida colorectal cancer patients

Stacey L. Tannenbaum, Monique Hernandez, D. Dandan Zheng, Daniel A Sussman, David J Lee

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose: 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. Conclusion: 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.

Original languageEnglish (US)
Article numbere106322
JournalPLoS One
Volume9
Issue number8
DOIs
StatePublished - Aug 29 2014

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colorectal neoplasms
Colorectal Neoplasms
Age Groups
Mortality
Medicaid
risk groups
health services
neoplasms
Comorbidity
veterans
Delivery of Health Care
Widowhood
Neoplasms
census data
United States Department of Veterans Affairs
Divorce
insurance
Censuses
Medicare
Insurance

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Individual- and neighborhood-level predictors of mortality in Florida colorectal cancer patients. / Tannenbaum, Stacey L.; Hernandez, Monique; Zheng, D. Dandan; Sussman, Daniel A; Lee, David J.

In: PLoS One, Vol. 9, No. 8, e106322, 29.08.2014.

Research output: Contribution to journalArticle

Tannenbaum, Stacey L. ; Hernandez, Monique ; Zheng, D. Dandan ; Sussman, Daniel A ; Lee, David J. / Individual- and neighborhood-level predictors of mortality in Florida colorectal cancer patients. In: PLoS One. 2014 ; Vol. 9, No. 8.
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abstract = "Purpose: 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. Conclusion: 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.",
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