Impact of treatment and insurance on socioeconomic disparities in survival after adolescent and young adult Hodgkin lymphoma: A population-based study

Theresa H M Keegan, Mindy C. Derouen, Helen M. Parsons, Christina A. Clarke, Debbie Goldberg, Christopher R. Flowers, Sally L. Glaser

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Background: Previous studies documented racial/ethnic and socioeconomic disparities in survival after Hodgkin lymphoma among adolescents and young adults (AYA), but did not consider the influence of combined-modality treatment and health insurance. Methods: Data for 9,353 AYA patients ages 15 to 39 years when diagnosed with Hodgkin lymphoma during 1988 to 2011 were obtained from the California Cancer Registry. Using multivariate Cox proportional hazards regression, we examined the impact of sociodemographic characteristics [race/ethnicity, neighborhood socioeconomic status (SES), and health insurance], initial combined- modality treatment, and subsequent cancers on survival. Results: Over the 24-year study period, we observed improvements in Hodgkin lymphoma-specific survival by diagnostic period and differences in survival by race/ethnicity, neighborhood SES, and health insurance for a subset of more recently diagnosed patients (2001-2011). In multivariable analyses, Hodgkin lymphoma-specific survival was worse for Blacks than Whites with early-stage [HR: 1.68; 95% confidence interval (CI): 1.14-2.49] and late-stage disease (HR: 1.68; 95% CI, 1.17-2.41) and for Hispanics than Whites with late-stage disease (HR: 1.58; 95% CI, 1.22-2.04). AYAs diagnosed with early-stage disease experienced worse survival if they also resided in lower SES neighborhoods (HR: 2.06; 95% CI, 1.59-2.68). Furthermore, more recently diagnosed AYAs with public health insurance or who were uninsured experienced worse Hodgkin lymphoma- specific survival (HR: 2.08; 95% CI, 1.52-2.84). Conclusion: Our findings identify several subgroups of Hodgkin lymphoma patients at higher risk for Hodgkin lymphoma mortality. Impact: Identifying and reducing barriers to recommended treatment and surveillance in these AYAs at much higher risk of mortality is essential to ameliorating these survival disparities.

Original languageEnglish (US)
Pages (from-to)264-273
Number of pages10
JournalCancer Epidemiology Biomarkers and Prevention
Issue number2
StatePublished - Feb 2016

Bibliographical note

Funding Information:
This work was supported by the Stanford Cancer Institute (to T.H.M. Keegan), the Cancer Prevention Institute of California (to S.L. Glaser), the NCI''s SEER Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California (to M.C. DeRouen, C.A. Clarke, and D. Goldberg), and an NCI Career Development Award (K07CA175063; to H.M. Parsons). The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; theNCI''s SEER Programunder contractHHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention''s National Program of Cancer Registries, under agreementU58DP003862-01 awarded tothe CaliforniaDepartment of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the NCI, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

Publisher Copyright:
© 2016 American Association for Cancer Research.


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