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

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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.

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Abbreviations

SES:

Socioeconomic status

iSES:

individual-level socioeconomic status

nSES:

neighborhood-level socioeconomic status

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Cancer Prevention Fellowship Program, National Cancer Institute, National Institutes of Health, 6116 Executive Blvd, Room 404, Bethesda, MD, 20892, USA

    Erin E. Kent

  2. Department of Epidemiology, University of California, Irvine, Irvine, CA, USA

    Erin E. Kent, Leonard S. Sender, Argyrios Ziogas & Hoda Anton-Culver

  3. Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA

    Leonard S. Sender & Hoda Anton-Culver

  4. Hyundai Cancer Institute, CHOC Children’s Hospital, Orange, CA, USA

    Leonard S. Sender & Rebecca A. Morris

  5. Institute for Health Promotion and Disease Prevention, Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA

    Timothy J. Grigsby

  6. Department of Anthropology, University of California, Irvine, Irvine, CA, USA

    Michael J. Montoya

  7. Department of Chicano/Latino Studies, University of California, Irvine, Irvine, CA, USA

    Michael J. Montoya

  8. Department of Population Health and Prevention, University of California, Irvine, Irvine, CA, USA

    Michael J. Montoya

  9. Genetic Epidemiology Research Institute, University of California, Irvine, Irvine, CA, USA

    Argyrios Ziogas & Hoda Anton-Culver

Authors
  1. Erin E. Kent
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  2. Leonard S. Sender
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  3. Rebecca A. Morris
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  4. Timothy J. Grigsby
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  5. Michael J. Montoya
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  6. Argyrios Ziogas
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  7. Hoda Anton-Culver
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Corresponding author

Correspondence to Erin E. Kent.

Appendices

Appendix 1

See Fig. 1

Fig. 1
figure 1

Population-based case ascertainment flow diagram. An additional six participants from a clinic-based recruitment were also added to the analysis

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Appendix 2

See Table 6.

Table 6 Factor loadings (>0.3) for individual SES indicators after oblique rotation
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Appendix 3

See Table 7.

Table 7 Interfactor correlations for individual SES factors
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Kent, E.E., Sender, L.S., Morris, R.A. et al. Multilevel socioeconomic effects on quality of life in adolescent and young adult survivors of leukemia and lymphoma. Qual Life Res 22, 1339–1351 (2013). https://doi.org/10.1007/s11136-012-0254-z

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