Disparities In Health-related Quality Of Life Research Articles

Psychosocial factors mediate social inequalities in health-related quality of life among children and adolescents

BackgroundThe present analysis aimed to assess the mediating role of psychosocial and behavioural factors in socio-economic inequalities in health-related quality of life (HRQoL) among children and adolescents.MethodsCross-sectional data was drawn from the randomly selected SEROCoV-KIDS cohort study in Geneva, Switzerland. Associations of socio-economic conditions (parents’ highest education, household financial situation) with HRQoL, psychosocial (parent–child relationship, school difficulties, friends, extracurricular activities) and behavioural factors (screen time, physical activity, green spaces time, sleep duration), along with associations of psychosocial and behavioural factors with HRQoL, were evaluated with generalized estimating equations. Counterfactual mediation analyses were conducted to test pathways linking socio-economic conditions to HRQoL.ResultsOf 965 children and 816 adolescents, those with disadvantaged financial circumstances were more likely to have a poor HRQoL (adjusted Odds Ratio [aOR]: 3.80; 95% confidence interval [CI]: 1.96–7.36 and aOR: 3.66; 95%CI: 2.06–6.52, respectively). Psychosocial characteristics mediated 25% (95%CI: 5–70%) and 40% (95%CI: 18–63%) of financial disparities in HRQoL among children and adolescents, respectively. Health behaviours were weakly patterned by socio-economic conditions and did not contribute to financial differences in HRQoL.ConclusionsThese findings provide empirical evidence for mechanisms explaining socio-economic disparities in child HRQoL and could inform interventions aimed to tackle health inequalities.

Socio-economic inequalities in health-related quality of life and the contribution of cognitive impairment in Australia: A decomposition analysis

BackgroundThe distributional effects of cognitive impairment on inequalities in health-related quality of life (HRQoL) are not well studied. This relationship has not been studied in any Australian health inequality literature. Therefore, this study aims to examine how cognitive impairment affects the distribution of HRQoL across various socio-economic classes amongst older Australians. MethodsData for this study was collected from the Household, Income and Labour Dynamics in Australia (HILDA) survey. The final analysis consisted of 5,247 and 5,614 unique individuals from wave 2012 and wave 2016, respectively. An ordinary least squares (OLS) regression model was used to investigate the relationship between cognitive impairment and HRQoL. Additionally, the Wagstaff-Doorslaer-Watanabe standard concentration index was used to examine socioeconomic inequality in HRQoL. ResultsThe findings revealed pro-rich inequalities in HRQoL, as indicated by the concentration indices of 0.029 and 0.025 for wave 12 and wave 16, respectively. Additionally, the results showed that mild cognitive impairment accounted for 7.60% and 9.03%, respectively, of pro-rich socioeconomic inequality in HRQoL in 2012 and 2016. ConclusionPeople from lower socioeconomic status (SES) groups tend to have lower HRQoL compared to those from higher SES. This leads to a greater disparity in HRQoL based on SES. Cognitive impairment positively contributed to this inequality in HRQoL. Therefore, it is critical to incorporate cognitive impairment into the design of interventions to reduce socioeconomic inequality in HRQoL.

Sex differences in health-related quality of life among older Korean adults with type 2 diabetes mellitus: a cross-sectional study

Objectives: This cross-sectional study examined sex differences in Health-Related Quality of Life (HRQoL) among seniors with Type 2 Diabetes Mellitus (T2DM).Methods: Data from the Korea National Health and Nutrition Examination Survey (2008–2020) were analyzed. The EuroQol-5 Dimensions (EQ-5D), a measure of HRQoL, was used. It comprises five dimensions: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression, each with three levels.Results: Analysis of 3,826 older adults with T2DM showed a significant increasing trend in the EQ-5D Index from the 4th survey phase onwards (P for trend < 0.001 for both men and women). Men consistently reported higher EQ-5D levels than women across all survey years. Women’s EQ-5D levels remained lower than men’s, maintaining a decade-old disparity (P < 0.05). Men scored significantly higher (P < 0.05) in most EQ-5D domains, except for self-care and anxiety/depression, resulting in a higher total EQ-5D Index (P = 0.001). Increased comorbidities were strongly associated with lower EQ-5D levels in both sexes. Additionally, there was a negative correlation between the EQ-5D Index and refined grain intake for both sexes (P for trend < 0.001), with high-EQ-5D groups consuming fewer refined grains. Women in the high-EQ-5D group consumed more nuts, vegetables, and meat compared to men (P for trend < 0.05).Conclusions: Our study highlights the sex disparities in HRQoL among older adults with T2DM. The findings suggest the need for tailored treatment guidelines aimed at improving the HRQoL of elderly T2DM patients, with a focus on their sex-specific characteristics. Implementing these tailored guidelines could enhance the HRQoL of older women with T2DM and promote more equitable healthcare outcomes. This underscores the importance of considering sex differences to comprehensively improve the well-being of this population.

Examining health-related quality of life in ambulatory adult patients with chronic heart failure: insights from Malaysia using EQ-5D-5L.

Health-related quality-of-life (HRQoL) data for the chronic heart failure (HF) population in Malaysia are lacking. Using EQ-5D-5L, this study intended to describe their HRQoL, identify predictors of worse HRQoL, and derive EQ-5D-5L index scores for use in economic evaluations. A cross-sectional survey was conducted between April and September 2023 to collect EQ-5D-5L, sociodemographic, and clinical data from outpatients with HF across seven public specialist hospitals in Malaysia. Multivariable logistic and linear regression models were used to identify independent predictors of reported problems in the EQ-5D-5L dimensions, and predictors of index scores and EQ-VAS, respectively. EQ-5D-5L data from 424 outpatients of multi-ethnic background (mean age: 57.1years, 23.8% female, mean left ventricular ejection fraction: 35.7%, 89.7% NYHA class I-II) were collected using either Malay, English, or Chinese, achieving a 99.8% completion rate. Nearly half of the respondents reported issues in the Mobility, Usual Activities, and Pain/Discomfort dimensions. Mean EQ-5D-5L index was 0.820, lower than the general population, and significantly lower with NYHA class III-IV (0.747) versus NYHA class I (0.846) and NYHA class II (0.805). Besides NYHA class, independent predictors of worse HRQoL included Indian ethnicity, living alone, lower education, unemployment due to ill-health, and proxy-reported HRQoL, largely aligning with existing literature. Community-dwelling Malaysians with HF reported poorer HRQoL compared to the general population. The observed disparities in HRQoL among HF patients may be linked to specific patient characteristics, suggesting potential areas for targeted interventions. HRQoL assessment using EQ-5D-5L proves feasible and should be considered for routine implementation in local clinics.

Health-Related Quality of Life of Adolescents and Children With Type 1 Diabetes in the Jazan Region of Saudi Arabia.

Type 1 diabetes mellitus (T1DM) is increasingly prevalent among Saudi Arabian youth, particularly in the Jazan region. This chronic condition necessitates lifelong insulin therapy and poses significant daily management challenges for affected adolescents. Despite the high incidence rates, there is a notable lack of research into how T1DM impacts the health-related quality of life (HRQoL) of these individuals. This study aimed to assess HRQoL and its demographic correlates in T1DM patients in the Jazan region of Saudi Arabia. In this cross-sectional study, 236 T1DM patients completed the Pediatric Quality of Life Inventory Diabetes Module 3.0 (PedsQL DM). The HRQoL across domains of diabetes symptoms, treatment barriers, adherence, worry, and communication was compared by gender, nationality, age, education, residence, and healthcare follow-up using t-tests and ANOVA. Multivariate regression identified predictors of overall HRQoL. Most respondents were female (51.3%), 42.8% were between the ages of seven and 12 years, and 94.5% were Saudi nationals. Males reported better HRQoL than females, with fewer symptoms, treatment barriers, and better communication (all p<0.05). Non-Saudis had better treatment adherence, communication, and overall HRQoL than Saudis (all p<0.05). Older children (13-18 years) reported lower treatment barriers than younger children (three to six years) (p<0.05). Those with intermediate education had lower treatment barriers than those with preliminary education (p = 0.038). Only the female gender (-0.171, p = 0.009) independently predicted poorer overall HRQoL. This study revealed disparities in HRQoL among T1DM children and adolescents. Males, non-Saudis, older children, and those with more education had better HRQoL. Females were at particular risk for poorer outcomes. Targeted interventions are needed to address this region's demographic disparities in diabetes-related HRQoL.

Socioeconomic inequality of health-related quality of life in cancer survivors in South Korea.

We investigated the inequalities in health-related quality of life (HRQoL) among cancer survivors in Korea, focusing on income and education levels. The slope index of inequality (SII) and relative index of inequality (RII) were utilized to analyze these disparities. Data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2021 was analyzed. The HRQoL was assessed using the EQ-5D questionnaire, which included five problem areas: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Logistic regression was employed to calculate the odds ratios (ORs) for each education and income level, indicating the probability of reporting problems. Furthermore, the slope index of inequality (SII) and relative index of inequality (RII) were calculated to evaluate the inequalities in HRQoL. Among the 3396 cancer survivors, a considerable proportion reported pain/discomfort (29.6%) and mobility problems (21.1%). The logistic regression results demonstrated a higher likelihood of experiencing problems in all five EQ-5D items among individuals with lower income or education levels. Specifically, compared to the high-income group, the adjusted ORs for mobility problems were 2.19, 1.64, and 1.08 for the low, low-medium, and medium-high-income groups, respectively (p-value < 0.05). Notably, significant income inequalities in HRQoL problems were observed, with the greatest disparities seen in self-care and usual activity problems, as indicated by the SII and RII values. Socioeconomic disparities in HRQoL exist among cancer survivors in Korea, particularly related to income levels. Addressing the financial burdens of cancer treatment for individuals with low-income levels may help improve their HRQoL and mitigate these inequalities.

Racial and Ethnic Disparities in Health-Related Quality of Life for Patients with Colorectal Cancer: Analysis of the SEER-MHOS Linked Data Set

We hypothesized that racial and ethnic disparities exist in health-related quality of life (HRQOL) among older adults with colorectal cancer, both before and after diagnosis. The Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey (SEER-MHOS) linked data set was used to identify patients 65 years old and above who were diagnosed with colorectal cancer between 1996 and 2015. Self-reported race/ethnicity, the predictor of interest, was categorized as White (W), Asian/Pacific Islander (API), Black/African American (B), or Hispanic (H). HRQOL data from the 36-Item Short Form Survey and Veterans RAND 12-Item Health Survey were extracted within 24 months pre- and post-diagnosis. HRQOL was measured using the Physical Component Summary (PCS), Mental Component Summary (MCS), and Total Component Summary (TCS, a summation of PCS and MCS), which were the response variables. Associations were assessed via univariable (UVA) and multivariable (MVA) linear regression analysis, adjusting for age, sex, region, marital status, education, income, number of comorbidities, limitations in activities of daily living, stage, and histology. Pairwise comparisons were performed between all racial and ethnic groups. We identified a total of 1,204 evaluable patients, with 815 in the pre-diagnosis cohort and 562 in the post-diagnosis cohort, including 173 patients in both. With unadjusted p-values, pre-diagnosis UVA revealed a higher mean PCS in API patients compared to W, B, and H patients (p<0.001, p<0.001, p = 0.02) as well as in W compared to H patients (p = 0.002); a higher mean MCS in W and API patients compared to B (p<0.001, p = 0.002) and H patients (p<0.001, p = 0.002); and a higher mean TCS in API compared to W, B, and H patients (p = 0.027, p<0.001, p<0.001) as well as in W compared to B and H patients (p<0.001, p = 0.012). Pre-diagnosis MVA revealed a higher mean PCS in API compared to B patients (p = 0.028) and a higher mean MCS in W and B compared to H patients (p = 0.022, p = 0.021). Post-diagnosis UVA showed a higher mean MCS in W compared to B and H patients (p<0.001 for both) as well as in API compared to H patients (p = 0.002), and a higher mean TCS in W and API patients compared to B (p<0.001, p = 0.045) and H patients (p<0.001, p = 0.007). Post-diagnosis MVA showed a higher mean MCS in API compared to H patients (p = 0.035). Compared to pre-diagnosis, post-diagnosis mean TCS was numerically lower for all groups. Among older adults with colorectal cancer, there appear to be racial and ethnic disparities in HRQOL. Before the cancer diagnosis, API patients had better physical HRQOL than B patients, while W and B patients had better mental HRQOL than H patients. After diagnosis, API patients had better mental HRQOL than H patients. For all groups, the cancer diagnosis seemed to have a negative impact on overall HRQOL.

Disparities in health-related quality of life among lesbian, gay, and bisexual cancer survivors

Objective This study compared health-related quality of life (HRQOL) among lesbian, gay, and bisexual (LGB) cancer survivors and their heterosexual counterparts in a US population-based sample of cancer survivors. Methods The study utilized data from the All of Us research program. LGB survivors (n = 885) were matched for age, gender identity, marital status, income, education, and cancer site with heterosexual survivors (n = 885) using 1:1 propensity matching. Physical, mental, and social HRQOL were assessed with items from the Patient-Reported Outcomes Measurement Information System (PROMIS). Results Relative to heterosexuals, LGB cancer survivors reported lower HRQOL in mental and social domains, but not in physical HRQOL. Older age was associated with higher HRQOL across domains. LGB survivors identifying as Black/African American were more likely to experience lower social HRQOL than White survivors. Conclusions This study highlights several disparities in HRQOL that exist between LGB and heterosexual cancer survivors.

Health-related quality of life disparities among Hispanic/Latinx patients with nephrolithiasis

It is documented that Hispanic/Latinx kidney stone formers have inferior health-related quality of life (HRQoL) compared to the general population. We hypothesized that socioeconomic factors drive HRQoL disparities. Specifically, we sought to determine if medical insurance type is associated with HRQoL disparities among Hispanic/Latinx stone formers. This was a prospective cohort observational study of patients with kidney stones across the University of San Diego Health Care System. Patients enrolled from June 2018 to August 2020 completed a validated Wisconsin Stone Quality of Life questionnaire (WISQoL). Patient characteristics and self-reported HRQoL were compared between Hispanic/Latinx and non-Hispanic/Latinx stone formers using MANCOVA and ordinal logistic regression. Matched group comparisons were performed based on age, gender, body mass index, stone symptoms, and insurance type using MACOVA. A total of 270 patients were enrolled (Hispanic/Latinx n = 88; non-Hispanic/Latinx n = 182). Hispanic/Latinx stone formers had higher rates of public insurance at baseline (p < 0.001) with significantly lower HRQoL [social impact (p = 0.007)]. However, a matched cohort comparison demonstrated no differences. On multivariate analysis, private insurance increased the likelihood of having higher HRQoL (OR 2.21, p = 0.021), while stone symptoms (OR = 0.06, p < 0.001) and emergency department visits (OR = 0.04, p = 0.008) decreased chances of higher HRQoL. Ethnicity was not a significant factor in HRQoL scores on multivariate analysis. Our analysis suggests that differences in HRQoL among Hispanic/Latinx stone formers may be primarily driven by socioeconomic factors as opposed to clinical or racial differences. Specifically, source of insurance appears to have significant effect on HRQoL in this ethnic group.

Abstract WMP11: Health-related Quality Of Life After Thrombolysis In Acute Stroke: Results From The Act Trial

Background and aims: Recent evidence from thrombolysis trials indicate the non-inferiority of the Tenecteplase (TNK) to the Alteplase (TPA) with respect to functional outcomes in acute stroke patients. This study examines the predictors of patient-reported health-related quality of life (HRQOL) in acute stroke patients who received thrombolysis therapy. Methods: Data were used from all acute stroke patients included in AcT, a pragmatic, registry-linked randomized trial comparing TNK with TPA. HRQOL at 90-day post-randomization was assessed using the EuroQol-5D-5L (EQ-5D) visual analogue scale (VAS). Based on the Canadian norms, health state utilities were estimated from the EQ-5D items using the EQ-5D time trade-off approach. Tobit regression model and linear mixed-effects regression were used to evaluate the adjusted effect of type of treatment on health utility scores and VAS score, respectively. Results: Of the 1262 patients included in this analysis, 647(51.3%) were administered the TNK, 584(46.3%) were female, and 380(30.1%) were greater than or equal to 80 years old. There was no significant adjusted effect of the type of thrombolysis on health utility scores (adjusted beta coefficient [95%CI] = 0.029 [-0.001, 0.062]), but patients who received TNK reported higher adjusted VAS scores than those that received TPA [adjusted beta coefficient [95%CI] = 2.1 [-0.29, 4.49]). Older age (p &lt; 0.01), female sex (p = 0.01), higher NIHSS score (p &lt; 0.01) were associated with lower health utilities and VAS scores. Conclusion: There is no differential effect of the type of thrombolysis on patient-reported global HRQOL and health state utilities of acute stroke patients. Disparities in HRQOL were mainly explained by sex, age, and disease severity.

34141 A survey of health-related quality of life disparities in cutaneous T-cell lymphoma patients with skin of color

Introduction: Cutaneous T-cell lymphoma (CTCL) can have significant impacts on functional, physical, social, and psychological health-related quality of life (HRQoL). Recent research has acknowledged prominent outcome differences affecting CTCL patients with skin of color (SOC), however, differences in HRQoL between SOC and non-SOC populations are poorly understood.

Differences in Health-Related Quality of Life and Health Behaviors Among Lesbian, Bisexual, and Heterosexual Women Surviving Cancer from the 2013 to 2018 National Health Interview Survey.

Purpose: Health-related quality of life (HRQoL) and health behaviors contribute to cancer morbidity and mortality, which are elevated in lesbian and bisexual women (LBW). The purpose of this study was to assess differences in HRQoL and health behaviors between heterosexual and lesbian women and heterosexual and bisexual women cancer survivors. Methods: We pooled 2013-2018 National Health Interview Survey data. HRQoL comprised physical, mental, financial, and social health domains. Health behaviors included tobacco and alcohol use, physical activity, and preventive health care. Weighted, multivariable logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (CIs). Results: The sample included 10,830 heterosexual, 141 lesbian, and 95 bisexual cancer survivors. Lesbian women reported higher odds of fair/poor self-rated health (OR: 1.68, 95% CI 1.02-2.78), chronic obstructive pulmonary disease (OR: 1.98, 95% CI 1.09-3.56), and heart conditions (OR: 1.90, 95% CI 1.16-3.12) than heterosexual women. Bisexual women reported higher odds of severe psychological distress (OR: 3.03, 95% CI 1.36-6.76), heart conditions (OR: 1.98, 95% CI 1.12-3.53), and food insecurity (OR: 2.89, 95% CI 1.29-6.50) than heterosexual women. For health behaviors, lesbian women reported greater odds of current (OR: 2.34, 95% CI 1.26-4.34) and former tobacco use (OR: 1.89, 95% CI 1.21-2.96), and bisexual women had lower odds of a recent mammogram (OR: 0.42, 95% CI 0.23-0.78) than heterosexual women. Conclusions: LBW cancer survivors reported disparities in HRQoL and health behaviors. In cancer care settings, identification of LBW patients requiring physical and mental health promotion, financial services, and supported tobacco cessation may improve health and survival.

Racial/ethnic differences in health-related quality of life among Hawaii adult population

BackgroundThis study examined racial/ethnic differences in health-related quality of life (HRQOL) among adults and identified variables associated with HRQOL by race/ethnicity.MethodsThis study was conducted under a cross-sectional design. We used the 2011–2016 Hawaii Behavioral Risk Factor Surveillance System data. HRQOL were assessed by four measures: self-rated general health, physically unhealthy days, mentally unhealthy days, and days with activity limitation. Distress was defined as fair/poor for general health and 14 days or more for each of the other three HRQOL measures. We conducted multivariable logistic regressions with variables guided by Anderson’s behavioral model on each distress measure by race/ethnicity.ResultsAmong Hawaii adults, 30.4% were White, 20.9% Japanese, 16.8% Filipino, 14.6% Native Hawaiian and Pacific Islander (NHPI), 5.9% Chinese, 5.2% Hispanics, and 6.2% Other. We found significant racial/ethnic differences in the HRQOL measures. Compared to Whites, Filipinos, Japanese, NHPIs, and Hispanics showed higher distress rates in general health, while Filipinos and Japanese showed lower distress rates in the other HRQOL measures. Although no variables were consistently associated with all four HRQOL measures across all racial/ethnic groups, history of diabetes were significantly associated with general health across all racial/ethnic groups and history of depression was associated with at least three of the HRQOL measure across all racial/ethnic groups.ConclusionsThis study contributes to the literature on disparities in HRQOL and its association with other variables among diverse racial/ethnic subgroups. Knowing the common factors for HRQOL across different racial/ethnic groups and factors specific to different racial/ethnic groups will provide valuable information for identifying future public health priorities to improve quality of life and reduce health disparities.

Abstract PO-081: The relationship between socioeconomic status and nutritional intake in older female cancer survivors

Abstract Background: As older adults (65+) are the age cohort most likely to be diagnosed with cancer and women tend to live longer than men, many cancer survivors are older females. However, older female survivors are an understudied group. Lifestyle behaviors such as maintaining a healthy diet have been shown to promote disease- free survivorship and improve health-related quality of life (HRQoL). Moreover, socioeconomic factors (e.g. income, education) have been shown to influence survivors’ lifestyle behaviors and long-term health outcome. However, socioeconomic factors that influence the diet quality of older female survivors have been greatly understudied in this population. This study sought to examine the influence of socioeconomic factors on the nutritional intake of older female survivors, while also investigating disparities in HRQoL and self-rated health. Methods: Older women, with all cancer types and stages, who completed primary cancer treatment (i.e., chemotherapy, surgery, radiation) within the past five years, were eligible to participate. Older female survivors completed one-time surveys to assess HRQoL (RAND-36), body mass index (BMI), diet quality (Diet History Questionnaire II), and self-rated health. Demographic information and medical record data were also collected. Diet History Questionnaire II results were converted to 2015-2020 Healthy Eating Index (HEI) scores. Descriptive analyses, correlations, and stepwise linear regressions were utilized. Results: Participants (n=171) were, on average, 72.72 ±7.40 years old, and the majority were white (90.0%), had a household income between $20,000 and $100,000 (53.8%), completed at least a bachelor’s degree (54.7%), and were breast cancer survivors (68.0%). Mean BMI was 27.71±6.20 (overweight) with 63.7% of the participants being overweight or obese. Participant’s average physical and mental HRQoL composite scores were 41.94±10.50 and 48.47±7.18, respectively, out of 100. The mean HEI-2015 score of participants was 66.54±10.01, out of 100. Having higher educational attainment (β=0.417, p=0.032) and greater physical HRQoL (β=0.430, p=0.028) was associated with higher HEI scores. Having higher educational attainment (β=0.574, p=0.004) was also associated with higher mental HRQoL, and higher physical HRQoL (β=0.679, p&amp;lt;0.001) was associated with better self-rated health. Conclusions: Older female cancer survivors were found to have poor diet quality and high rates of being overweight or obese. Nutritional intake and HRQoL were found to be interrelated and associated with educational attainment. Results indicate the need for nutritional screening and consulting during cancer survivorship. Tailored lifestyle interventions, considering socioeconomic status, may improve the diet quality of older female survivors and help prevent chronic disease, mitigate treatment effects, and improve HRQoL in this underserved population. Citation Format: Christian Stephens, Jill Clutter, Jessica Krok-Schoen. The relationship between socioeconomic status and nutritional intake in older female cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-081.

Abstract B039: The impact of social and built environments on quality of life among cancer survivors

Abstract Background: With over 16 million cancer survivors in the U.S., understanding factors that improve health-related quality of life (HRQOL) after cancer diagnosis is critical. Previous studies have identified demographic, clinical and behavioral factors that shape HRQOL among cancer patients and have observed poorer HRQOL among racial/ethnic minorities, individuals of low socioeconomic status (SES), or those with comorbidities. Few studies have considered the influence of neighborhood factors (census block group SES (nSES), census tract poverty, county segregation) on HRQOL. Thus, we proposed to assess racial/ethnic disparities in HRQOL and evaluate the extent to which these disparities are explained by neighborhood factors. Methods: We pooled data on 2,500 diverse (i.e., multiethnic, varied SES, multiple cancer sites) cancer survivors from three population-based cancer survivorship studies in California and linked them to the California Neighborhoods Data System. Separately for the two continuous HRQOL outcomes (physical and mental composite scores, PCS and MCS, from SF36), using a 3-level model with participants nested within block groups, which are nested within study/region, we calculated least squares means and parameter estimates for each racial/ethnic group, with and without adjustment for covariates. Predisposing factors included age, gender, education, employment, income, health insurance status, marital status and significant clinical and tumor characteristics. Health behaviors included physical activity and body mass index. Results: Among 2,477 cancer survivors, we observed racial/ethnic disparities in HRQOL, with African Americans reporting the lowest (worst) PCS (42.7), Latinos reporting the lowest MCS (48.4) and Asians/Pacific Islanders reporting the highest scores (PCS: 45.4; MCS: 51.1) in unadjusted models. In models adjusted for age and cancer recurrence (and stage for PCS), both PCS and MCS increased with higher nSES. Assessed separately, the following neighborhood factors were associated with decreased MCS after adjusting for nSES: higher population density, street connectivity (gamma), % renting, % non-single-family units, more parks, and restaurant index (more unhealthy). No other neighborhood factor was associated with PCS after adjusting for nSES. Compared to non-Hispanic (NH) Whites, African American disparities in PCS were fully attenuated after adjusting for nSES. Similarly adjusting for neighborhood factors fully attenuated Hispanic disparities in MCS. For PCS, adjusting for predisposing, nSES, and/or behavioral factors resulted in Hispanics having better HRQOL compared to NH Whites. Conclusions: Among a diverse cohort of cancer survivors, neighborhood attributes were associated with HRQOL. Racial/ethnic disparities in HRQOL were attenuated with inclusion of neighborhood factors in the models. Elucidating the pathways through which these neighborhood attributes impact HRQOL will be important to improving survivorship outcomes. Citation Format: Salma Shariff-Marco, Alison J. Canchola, Theresa H.M. Keegan, Alyssa Nickell, Ingrid Oakley-Girvan, Ann S. Hamilton, Scarlett L. Gomez. The impact of social and built environments on quality of life among cancer survivors [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B039.

Trends in Racial/Ethnic Disparity of Health-Related Quality of Life in Older Adults with and without Cancer (1998-2012).

Non-White cancer survivors often report poorer health compared with Non-Hispanic Whites. Whether those disparities are changing over time is unknown. We examined changes in health-related quality of life (HRQOL) by race/ethnicity from 1998 to 2012 among older adults with and without cancer. Data from Medicare Advantage beneficiaries were obtained from the linkage between the Medicare Health Outcomes Survey and Surveillance, Epidemiology, and End Results cancer registry data (SEER-MHOS). HRQOL was assessed with the SF-36/VR-12 Physical and Mental Component Scores (PCS/MCS) and 8 scales (Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Mental Health, Role-Emotional). Annual average HRQOL scores, adjusting for age at survey, gender, number of comorbidities, education, and SEER registry, were compared over time. Absolute (between-group variance; BGV) and relative (mean log deviation; MLD) indices of disparity were generated using the National Cancer Institute's health disparities calculator (HD*Calc). Joinpoint was used to test for significant changes in the slopes of the linear trend lines. Racial/ethnic disparities in MCS increased in absolute and relative terms over time for those with [BGV = 15.8 (95% confidence interval [CI], 10.2-21.6); MLD = 16.2 (95% CI, 10.5-22.1)] and without [BGV = 19.3 (95% CI, 14.9-23.8); MLD = 19.6 (95% CI, 15.2-24.0)] cancer. PCS disparities over time did not significantly change. Changes in disparities in 5 of 8 HRQOL scales were significant in those with and without cancer. Older adults with cancer show increasing racial/ethnic disparities in HRQOL, particularly in mental health status. Future research should evaluate trends in HRQOL and explore factors that contribute to health disparities.

Abstract B036: Self-perceived health status, poor physical and mental health days among cancer survivors with different socioeconomic status

Abstract Background: Health-related quality of life (HRQOL) is multidimensional and is composed of, at a minimum, self-perceived health status, physical functioning and psychological well-being. HRQOL measures reflect the extent of disability and dysfunction associated with a chronic disease such as cancer. Self-perceived health status is a good proxy for disease burden among cancer patients. Purpose: This study used a nationally representative population survey to examine socioeconomic status disparities in HRQOL among survivors of thyroid, colon, lung, cervical, breast, prostate or ovarian cancer. Methods: Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey conducted by the CDC were used to examine factors associated with HRQOL among participants reported ever having been diagnosed with cancer. Typically, the cancer survivorship module is an optional component of the survey. However, the 2009 survey considered the cancer survivorship questions to be a core or required component of the survey. The BRFSS is a cross-sectional survey that assessed overall HRQOL, self-perceived health status, number of bad physical health and bad mental health days per month. Least square regression and logistic regression models, adjusting for confounding variables (e.g., age, gender, race/ethnicity, education level, and number of comorbidities), were used for ordinal and dichotomous (5 (bad) vs 1-4 (excellent, very good, good, fair)) scale of HRQOL, respectively. Results: Among 432,607 surveyed, 59,173 reported ever been diagnosed with cancer. The seven most reported cancers were the focus of this study. Mean score for self-perceived health status (5-point scale) among survivors of thyroid, colon, lung, cervical, breast, prostate, and ovary was 2.83 (1.10), 3.15 (1.12), 3.68 (1.12), 2.98 (1.17), 2.93 (1.09), 2.94 (1.10), and 3.16 (1.18), respectively. After adjusting for confounders, a positive dose-response effect was observed between income level and all three HRQOL measures across all seven cancer sites. Income was consistently and inversely associated with a higher chance for reporting poorer HRQOL [OR: 0.64, 95% CI: 0.57-0.71], [OR: 0.63, 95% CI: 0.48-0.82], [OR: 0.67, 95% CI: 0.56-0.80], [OR: 0.69, 95% CI: 0.56-0.86], [OR: 0.55, 95% CI: 0.49-0.62], [OR:0.55, 95% CI: 0.44-0.69], [OR: 0.75, 95% CI: 0.62-0.91] among those with breast, thyroid, colon, lung, cervical, prostate, breast, and ovarian cancer, respectively. Race or ethnicity was not associated with in HRQOL among cancer survivors in the adjusted models. Conclusion: This study found income, but not race or ethnicity, is associated with HRQOL among cancer survivors, after adjusting for confounders in this nationally representative survey population. Household income appears to be a strong predictor of HRQOL among cancer survivors. Despite potential survival bias in this cross-sectional survey, it is possible that financial resources may lessen the overall burden of cancer survivors. Citation Format: Sarah N. O'Connor, L. Joseph Su. Self-perceived health status, poor physical and mental health days among cancer survivors with different socioeconomic status [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B036.

Socioeconomic disparities in health-related quality of life among colorectal cancer survivors.

Improvements in colorectal cancer (CRC) prevention, early detection, and treatment have resulted in substantial gains in survival. However, the health-related quality of life (HRQoL) of CRC survivors often depends on access to supportive care, which differs by survivors' socioeconomic characteristics. The purpose of this study was to investigate the relationship between socioeconomic characteristics and HRQoL in a diverse group of CRC survivors. We conducted a population-based, cross-sectional study to examine the association between socioeconomic factors (household income, health literacy, and insurance status) and HRQoL domains of pain interference, fatigue, physical function, sleep disturbance, anxiety, and depression. PROMIS® Short Forms v.2.0 were used to assess domains of HRQoL. Linear regression modeling was used to estimate the coefficient representing the average HRQoL domain score and its 95% confidence interval (CI). Three hundred one CRC survivors participated in the survey. Low-income (≤ $30,000) CRC survivors had, on average, a 4.70-point (95% CI 1.10-8.28) higher pain interference score, a 7.02-point (95% CI 3.27-10.77) higher fatigue score, a 5.13-point (95% CI - 8.56 to - 1.71) lower physical function score, and a 4.44-point (95% 1.40-7.49) higher depression score than CRC survivors with an income ≥ $70,000. Survivors with Medicaid insurance reported significantly greater pain interference and worse physical function than privately insured survivors. Survivors with low health literacy reported significantly greater pain interference compared with survivors with high health literacy. Substantial socioeconomic disparities in HRQoL were observed in this diverse population of CRC survivors. Designing supportive care interventions to improve HRQoL among low-income and Medicaid-insured CRC survivors is critical for eliminating disparities in CRC outcomes.

Chronic Respiratory Disease and Health-Related Quality of Life of African American Older Adults in an Economically Disadvantaged Area of Los Angeles.

Background. Most of the attention of policy makers, program planners, clinicians, and researchers in the area of physical health disparities among African American older adults has been traditionally focused on cardiometabolic disease and cancer. Among a long list of chronic medical conditions, chronic respiratory conditions (CRCs), such as asthma, chronic bronchitis, and emphysema, have received less attention. Purpose. This study investigated whether CRCs contribute to physical and mental health-related quality of life (HRQoL) of African American older adults who live in economically disadvantaged urban areas, and whether these effects are due to demographic factors, socioeconomic status (SES), health behaviors, and comorbid medical and mental conditions. Methods. This community-based study recruited 617 African American older adults (age ≥ 65 years) from Service Planning Areas (SPA) 6, an economically disadvantaged area in South Los Angeles. Structured face-to-face interviews were used to collect data on demographic factors (age and gender), SES (educational attainment and financial difficulty), living arrangements, marital status, health behaviors (cigarette smoking and alcohol drinking), health (CRC, number of comorbid medical conditions, depressive symptoms, and pain intensity), and physical and mental HRQoL (Physical and Mental Component Summary Scores; PCS and MCS; SF-12). Linear regressions were used to analyze the data. Results. The presence of CRCs was associated with lower PCS and MCS in bivariate analysis. The association between CRCs and PCS remained significant above and beyond all confounders. However, the association between CRCs and MCS disappeared after controlling for confounders. Conclusion. For African American older adults living in economically disadvantaged urban areas, CRCs contribute to poor physical HRQoL. Evaluation and treatment of CRCs in African American older adults may be a strategy for reduction of disparities in HRQoL in this population. As smoking is the major modifiable risk factor for CRCs, there is a need to increase accessibility of smoking cessation programs in economically disadvantaged urban areas. More research is needed on the types, management, and prognosis of CRCs such as asthma, chronic bronchitis, and emphysema in African American older adults who reside in low-income and resource limited urban areas.

Changes in health-related quality of life of Chinese populations measured by the EQ-5D-3\u2009L: a comparison of the 2008 and 2013 National Health Services Surveys

BackgroundsThe EuroQol Group Five-Dimensional (EQ-5D) instruments have been validated in China for measuring health-related quality of life (HRQoL) and are increasingly being used in health economic studies. However, there is paucity in the literature documenting long-term changes in the EQ-5D results in the Chinese populations. This study aims to identify such changes and their determinants using the EQ-5D-3 L instrument.MethodsData were obtained from the National Health Services Surveys in China, which included the EQ-5D-3 L since 2008. We compared the differences between the 2008 and 2013 surveys in the percentage of reported problems, visual analogue scale (VAS) scores, and the EQ-5D-3 L utility index derived from the national value sets. Factors associated with population changes in these EQ-5D results were identified using logistic, linear and Tobit regression models, respectively.ResultsCompared with 2008, reported problems in self-care (3.3% vs 3.1%), usual activities (4.8% vs 4.6%) and anxiety/depression (6.4% vs 5.3%) decreased, whereas reported problems in mobility (5.1% vs 5.9%) and pain/discomfort (9.3% vs 12.6%) increased significantly (p < 0.05) in 2013. The regression models revealed a rise (β = 1.61, p < 0.001) in VAS scores, but a slight drop (β = − 0.01, p < 0.001) in utility index in 2013 compared with 2008 after controlling for variations in demographic, behavioral, socioeconomic and residential variables. But the effect sizes of the changes over time (estimated by “average change divided by baseline standard deviation”) did not reach the threshold of clinical importance after adjustment for variations in other factors. Higher socioeconomic status (in terms of education, income and residential location) was associated with better EQ-5D-3 L results.ConclusionThe changing trend (decrease) of the utility index is contradictory to that (increase) of the VAS scores, although neither is deemed clinically important. It is evident that socioeconomic and regional disparities in HRQoL exist in China.