The Association Between Socioeconomic Factors at Diagnosis and Survival in Medulloblastoma: A Propensity Score-Matched Analysis and Population-Based Study.
Sihan Zhu, Zhuqing Cheng, Zuqing Wu, Qiangtian Liang, Siyu Chen, Ji Zhang, Zhenghe Chen, Fuhua Lin, Yinsheng Chen, Jian Wang
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引用次数: 0
Abstract
Background: Medulloblastoma (MB) is the most common malignant brain tumor of childhood. The associations between socioeconomic statuses (SES) and survival outcomes of medulloblastoma remain unclear. The aim of this study was to develop a nomogram to predict medulloblastoma specific death (MBSD) and overall survival (OS) in patients with medulloblastoma, taking into account socioeconomic factors in patients with medulloblastoma.
Methods: We included patients diagnosed with MB between 1975 and 2016 from the Surveillance, Epidemiology, and End Results database. Propensity Score Matching (PSM) was performed to reduce selection bias. Multivariate cox proportional hazards model was used to assess SES impact and clinically relevant variables of medulloblastoma specific death and overall survival. Independent prognostic factors determined by multivariate analysis were used to construct nomograms.
Results: A total of 2660 patients were enrolled after matching. Study showed unemployed rate (MBSD, high level vs. low level, P = 0.020) (OS, high level vs. low level, P = 0.017), and marital status (OS, married vs unmarried/unknown, P = 0.029) were important factors affecting prognosis of medulloblastoma in male. Meanwhile, median household income (MBSD, quartile 1 vs. quartile 3, P = 0.047) (OS, quartile 1 vs. quartile 2, P = 0.017) (OS, quartile 1 vs. quartile 3, P = 0.014), residence (MBSD, urban vs. rural, P = 0.041), and insurance status (MBSD, insured vs. uninsured/unknown, P = 0.002)(OS, insured vs. uninsured/unknown, P = 0.001) were significant factors affecting prognosis of medulloblastoma in female. Through the calibration plot and C-index test, our nomogram was also of predictive significance.
Conclusions: The unique features of MB have provided a scenario for analysis of the impact of racial, ethnic, gender, and socioeconomic factors. The current findings have important public health implications for achieving the goal of a healthy population. Given the known morbidity rates, long-term psychological, financial and medical burdens that these children and their families must bear, it is critical to identify and address these gaps.
背景：髓母细胞瘤（MB髓母细胞瘤（MB）是儿童时期最常见的恶性脑肿瘤。社会经济地位（SES）与髓母细胞瘤生存结果之间的关系仍不清楚。本研究的目的是在考虑髓母细胞瘤患者的社会经济因素的基础上，绘制一张预测髓母细胞瘤特异性死亡（MBSD）和髓母细胞瘤患者总生存率（OS）的提名图：我们从监测、流行病学和最终结果数据库中纳入了1975年至2016年间确诊为MB的患者。为减少选择偏倚，我们进行了倾向评分匹配（PSM）。采用多变量cox比例危害模型评估SES对髓母细胞瘤特异性死亡和总生存期的影响以及临床相关变量。多变量分析确定的独立预后因素被用于构建提名图：结果：经过配对后，共有 2660 名患者入选。研究显示，失业率（MBSD，高水平 vs. 低水平，P = 0.020）（OS，高水平 vs. 低水平，P = 0.017）和婚姻状况（OS，已婚 vs. 未婚/未知，P = 0.029）是影响男性髓母细胞瘤预后的重要因素。与此同时，家庭收入中位数（MBSD，四分位数1 vs. 四分位数3，P = 0.047）（OS，四分位数1 vs. 四分位数2，P = 0.017）（OS，四分位数1 vs. 四分位数3，P = 0.014）、居住地（MBSD，城市 vs. 农村，P = 0.041）也是影响男性髓母细胞瘤预后的重要因素。农村，P = 0.041）和保险状况（MBSD，有保险 vs. 无保险/未知，P = 0.002）（OS，有保险 vs. 无保险/未知，P = 0.001）是影响女性髓母细胞瘤预后的重要因素。通过校准图和C指数检验，我们的提名图也具有预测意义：髓母细胞瘤的独特特征为分析种族、民族、性别和社会经济因素的影响提供了一个场景。目前的研究结果对实现健康人口的目标具有重要的公共卫生意义。鉴于已知的发病率、这些儿童及其家庭必须承担的长期心理、经济和医疗负担，找出并解决这些差距至关重要。
期刊介绍：
Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.
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