Cancer
Disparities by Neighborhood Racial and Ethnic Typology and Neighborhood Poverty in Survival among Adolescents and Young Adults with Cancer in Texas Jennifer Wang* Jennifer Wang Sandi Pruitt Caitlin Murphy
Background: We examined differences in survival by neighborhood racial/ethnic typology and neighborhood poverty among a population-based sample of adolescents and young adults (AYAs, age 15-39 years) diagnosed with cancer.
Methods: AYAs diagnosed with cancer between 1995 and 2015 were identified from the Texas Cancer Registry. Neighborhood racial/ethnic typology (predominantly White [PW], predominately Black [PB], predominately Hispanic [PH], multiethnic neighborhoods) and neighborhood poverty (+/-20% living below poverty) were defined using 2008-2012 American Community Survey data. Five-year survival by racial/ethnic typology and poverty were estimated. Cox proportional hazards models were used to examine associations with mortality, overall and by cancer type, adjusting for age and year at diagnosis, sex, and race/ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], Hispanic).
Results: Among 101,654 AYAs diagnosed with cancer (56.9% NHW, 11.8% NHB, 31.3% Hispanic), common cancer types were breast (15.0%), thyroid (11.4%), and lymphoma (11.2%). Five-year survival ranged from 66.6% (95% CI: 64.3%, 68.7%) for AYAs in PB neighborhoods to 83.2% (95% CI: 82.7%, 83.7%) for AYAs in PW neighborhoods. AYAs in higher (73.9%, 95% CI: 73.4, 74.4) vs. lower (81.5%, 95% CI: 81.2%, 81.8%) poverty neighborhoods had lower 5-year survival. In adjusted analyses, racial/ethnic typology (for example, PB vs. PW: HR 1.18, 95% CI: 1.07, 1.30) and poverty (high vs. low: HR: 1.25, 95% CI: 1.21, 1.29) were associated with worse survival. These associations varied by cancer type. For example, associations were elevated for AYAs with lymphoma (PH vs. PW: HR 1.36, 95% CI: 1.14, 1.63) but not for AYAs with genitourinary cancer (PH vs. PW: HR 0.81, 95% CI: 0.60, 1.09).
Discussion: AYAs in predominantly Black or Hispanic and higher poverty neighborhoods have poor survival. Further research is needed to examine why survival varies by cancer type and identify opportunities for intervention.