Article

Quality of Life Research

, Volume 22, Issue 6, pp 1339-1351

Multilevel socioeconomic effects on quality of life in adolescent and young adult survivors of leukemia and lymphoma

  • Erin E. KentAffiliated withCancer Prevention Fellowship Program, National Cancer Institute, National Institutes of HealthDepartment of Epidemiology, University of California, Irvine Email author 
  • , Leonard S. SenderAffiliated withDepartment of Epidemiology, University of California, IrvineChao Family Comprehensive Cancer Center, University of California, IrvineHyundai Cancer Institute, CHOC Children’s Hospital
  • , Rebecca A. MorrisAffiliated withHyundai Cancer Institute, CHOC Children’s Hospital
  • , Timothy J. GrigsbyAffiliated withInstitute for Health Promotion and Disease Prevention, Department of Preventive Medicine, University of Southern California
  • , Michael J. MontoyaAffiliated withDepartment of Anthropology, University of California, IrvineDepartment of Chicano/Latino Studies, University of California, IrvineDepartment of Population Health and Prevention, University of California, Irvine
  • , Argyrios ZiogasAffiliated withDepartment of Epidemiology, University of California, IrvineGenetic Epidemiology Research Institute, University of California, Irvine
  • , Hoda Anton-CulverAffiliated withDepartment of Epidemiology, University of California, IrvineChao Family Comprehensive Cancer Center, University of California, IrvineGenetic Epidemiology Research Institute, University of California, Irvine

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Adolescents and young adults Quality of life Socioeconomic status Health disparities Leukemia Lymphoma Cancer Cancer survivorship