ASPO Abstracts
Mortality disparities after adolescent and young adult cancer
Category: Cancer Health Disparities, Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2018
Abstract Body:
Adolescent and young adult (AYA) cancer patients may have unique mortality risk profiles compared to younger or older cancer patients. In addition to potential differences in tumor biology and treatment efficacy, AYAs often have unstable insurance coverage. With data from an existing study of 17,399 women with an incident, invasive cancer diagnosis at ages 15-39 in North Carolina during 2000-2013, we defined cancer deaths using ICD-10 codes for malignant neoplasms (C00-C97), and all other causes of death as noncancer deaths. Person-years were accrued from cancer diagnosis until death or December 31, 2014, whichever occurred first. We estimated 10-year cumulative incidence of cancer and noncancer death, accounting for the other as competing risks. Multivariable hazard ratios (HR) and 95% confidence intervals (CI) for cause-specific death were estimated using Cox proportional hazards regression models and were adjusted for cancer type, race (white, black, other), insurance status at diagnosis (private/military, Medicaid, other public insurance [Medicare or Indian/Public Health Service], uninsured, unknown), and age at diagnosis. During follow-up, there were 2,620 deaths due to cancer and 349 deaths from noncancer causes. Across cancer types, the 10-year cumulative incidence of cancer and noncancer death, respectively, were 23% and 2% for breast cancer, 6% and 2% for Hodgkin lymphoma, 5% and 0% for melanoma, 13% and 9% for non-Hodgkin lymphoma, 0% and 1% for thyroid cancer, 13% and 2% for gynecologic malignancies, and 32% and 4% for all other cancer types combined. Cancer and non-cancer mortality risks were higher among Blacks than Whites (HR=1.5; CI: 1.3-1.6 and HR=1.6; CI: 1.3-2.0, respectively). Compared to AYAs with private or military insurance at diagnosis, mortality was elevated for those with Medicaid (HR=1.8; CI: 1.6-2.0 and HR=2.9; CI: 2.2-3.9) and other public insurance (HR=1.8; CI: 1.5-2.2 and HR=6.6; CI: 4.6-9.5), but not for those who were uninsured (HR=1.1; CI: 1.0-1.3 and HR =1.1; CI: 0.7-1.9). Our findings highlight disparities according to race and insurance status among AYAs with cancer and the need for strategies to reduce mortality in vulnerable groups.
Keywords: adolescents and young adults, disparities, mortality