Multilevel socioeconomic effects on quality of life in adolescent and young adult survivors of leukemia and lymphoma
Cancer registry survival analyses have shown that adolescent and young adult patients with low socioeconomic status (SES) have reduced survival compared to those with higher SES. The objective of this study was to determine whether neighborhood- (nSES) and/or individual-level SES (iSES) also predicted current quality of life in adolescent and young adult survivors.
The Socioeconomics and Quality of Life study surveyed adolescent and young adult survivors of leukemia and lymphoma at least one year post-diagnosis using population-based ascertainment. Factor analysis was used to create a multidimensional age-relevant iSES score and compared with a preexisting census-block-group derived nSES score. Four quality of life domains were assessed: physical health, psychological and emotional well-being, social relationships, and life skills. Nested multivariable linear regression models were run to test the associations between both SES measures and quality of life and to compare the explanatory power of nSES and iSES.
Data from 110 individuals aged 16–40 were included in the final analysis. After adjustment for sociodemographic confounders, low nSES was associated only with poorer physical health, whereas low iSES was related to poorer quality of life in all four domains with iSES accounting for an additional 14, 12, 25, and 10 % of the variance, respectively.
Measures of SES at the individual as compared to the neighborhood level may be stronger indicators of outcomes in adolescents and young adults, which has important implications for SES measurement in the context of cancer surveillance.
KeywordsAdolescents and young adults Quality of life Socioeconomic status Health disparities Leukemia Lymphoma Cancer Cancer survivorship
individual-level socioeconomic status
neighborhood-level socioeconomic status
This work was carried out as part of Erin Kent’s doctoral dissertation at the University of California, Irvine. Support for this work was provided by a UC MEXUS dissertation grant and Centers for Disease Control and Prevention R36 Public Health Dissertation Grant R36DP002012-01). The authors thank undergraduate research assistants Marym Mohammady and Priyanka Saxena for their assistance with study recruitment coordination and clinical research coordinator Isabel Guzman for her assistance with translation of the study documents into Spanish.
Conflict of interest
The ideas expressed in the following paper are those of the authors and endorsement by the State of California, Department of Health Services, the National Cancer Institute, the Centers for Disease Control and Prevention, and/or the Genetic Epidemiology Research Institute of the University of California, Irvine is not intended, nor should it be inferred The SEOOL study was approved by the UC Irvine Institutional Review Board under Human Subjects Numbers 2006-4958 and 2009-7130. The authors have no financial interests to disclose.
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