评估美国成人眼类黑色素瘤的护理和预后的社会脆弱性
Assessment of Social Vulnerabilities of Care and Prognosis in Adult Ocular Melanomas in the US
影响因子:3.50000
分区:医学2区 / 外科2区 肿瘤学3区
发表日期:2024 May
作者:
Joshua A Mensah, David J Fei-Zhang, Jennifer L Rossen, Bahram Rahmani, David J Bentrem, Joshua D Stein, Dustin D French
摘要
先前的工作已经研究了社会决定因素对各种癌症的影响，但是对眼睛癌的分析有限。当前的文献倾向于集中于社会经济地位和种族，对跨学科贡献的稀疏分析。我们检查了通过疾病控制和预防中心（CDC）社会脆弱性指数（SVI），量化眼睛和轨道黑色素瘤差异的社会决定因素。对15,157例诊断为监测，eNdemology（Seemiology）的脑部脑部的诊断为15,157例患者的回顾性回顾性审查，并进行了跨越的157例患者。黑色素瘤。 SVI分数被抽象并与SEER患者数据匹配，其分数由县普查区的每个人口密度加权平均产生。主要结果是几个月存活，而次要结局是高级分期，高分和原次手术收据。随着总SVI得分提高，表明更多的脆弱性，我们观察到黑色素瘤组织学生存期的显着降低了23.1％（P <0.001），一级位点占19.6-39.7％。总SVI的增加显示出更高的分级几率（优势比[OR] 1.20，95％置信区间[CI] 1.02-1.43）和手术干预的几率降低（OR 0.94，95％CI 0.92-0.96）。在这四个主题中，在社会经济状况（26.0％）和住房运输（14.4％）中观察到更高的贡献（14.4％），而观察到较小的贡献的贡献则以少数语言状态（13.5％）和家庭组成（9.0％）（9.0％）（9.0％）（9.0％）（9.0％）（增加社会脆弱性）。黑色素瘤。量化哪些社会决定因素对差异最大的贡献。这为提供者旨在针对患者护理中非临床因素的最大影响社会决定因素奠定基础。
Abstract
Prior works have studied the impact of social determinants on various cancers but there is limited analysis on eye-orbit cancers. Current literature tends to focus on socioeconomic status and race, with sparse analysis of interdisciplinary contributions. We examined social determinants as measured by the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), quantifying eye and orbit melanoma disparities across the United States.A retrospective review of 15,157 patients diagnosed with eye-orbit cancers in the Surveillance, Epidemiology, and End Results (SEER) database from 1975 to 2017 was performed, extracting 6139 ocular melanomas. SVI scores were abstracted and matched to SEER patient data, with scores generated by weighted averages per population density of county's census tracts. Primary outcome was months survived, while secondary outcomes were advanced staging, high grading, and primary surgery receipt.With increased total SVI score, indicating more vulnerability, we observed significant decreases of 23.1% in months survival for melanoma histology (p < 0.001) and 19.6-39.7% by primary site. Increasing total SVI showed increased odds of higher grading (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.02-1.43) and decreased odds of surgical intervention (OR 0.94, 95% CI 0.92-0.96). Of the four themes, higher magnitude contributions were observed with socioeconomic status (26.0%) and housing transportation (14.4%), while lesser magnitude contributions were observed with minority language status (13.5%) and household composition (9.0%).Increasing social vulnerability, as measured by the CDC SVI and its subscores, displayed significant detrimental trends in prognostic and treatment factors for adult eye-orbit melanoma. Subscores quantified which social determinants contributed most to disparities. This lays groundwork for providers to target the highest-impact social determinant for non-clinical factors in patient care.