Socioeconomic and Racial Disparities in Survival for Adolescent and Young Adult Cancer Patients

Abstract

Background Adolescent and Young Adult (AYA) cancer patients have been historically understudied. Many improvements in survival observed for pediatric and older adult patients have not been paralleled in the AYA population. Contributing factors of this discrepancy may involve unique challenges AYA patients face, including poor investigative research, limited access to care, or financial insecurity. Several studies have identified that these challenges disproportionally impact AYA patients belonging to racial minority and lower socioeconomic (SES) groups, thus leading to worsened survival outcomes. We aimed to investigate differences in survival among AYA patients of different races, ethnicities, and SES treated within the same health care system, Kaiser Permanente Southern California (KPSC). Methods We identified patients, aged 15-39, diagnosed with the fourteen most common cancers in this age group at KPSC between the years 2010-2018, yielding 6,463 patients. Cancers included were breast, testis, leukemia, Non-Hodgkin and Hodgkin lymphoma, melanoma, colon, cervical, uterine, renal, brain, soft tissue, rectosigmoid, ovarian, stomach, and bone. The Neighborhood Deprivation Index (NDI), a validated measure of socioeconomic deprivation obtained from geocoded data of home addresses, was used as a marker of SES. Race, ethnicity, and survival data were obtained from the Electronic Health Record. We examined differences in survival rates for all cancer types, and breast cancer and leukemia separately, for NDI quartiles and racial and ethnic groups. Results Patients residing in the two most deprived areas have a higher all-cause mortality rate compared to those living in the two least deprived areas for all cancer types combined (p=0.0012). We did not detect a significant difference in survival rate between different NDI groups for patients with leukemia. White patients, compared to non-White patients, had statistically significant improved survival rates (p=0.0000036) for all cancer types combined. Black and Hispanic patients with leukemia had lower survival rates than Asian/Pacific Islander and White subjects with leukemia (p=0.0052). No difference was found among breast cancer patients of different NDI quartiles or races/ethnicities. Conclusion Patients experiencing higher levels of deprivation have lower survival rates compared to less deprived patients. White patients had significantly higher survival rates than Black, Hispanic, or Asian/Pacific Islander patients for all cancer types combined.