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Neighborhood socioeconomic status influences the survival of elderly patients with myelodysplastic syndromes in the United States

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Abstract

The potential role of socioeconomic status (SES) in the survival of patients with myelodysplastic syndromes (MDS) has not been evaluated. We conducted the first study to assess the prognostic role of neighborhood SES among a cohort of 2,118 patients (age ≥ 66 years) who were diagnosed with incident MDS in the United States during 2001–2002. Principal component analysis was used to develop a summary SES score by combining multiple measures of neighborhood SES. The score was then used to classify the census tract each patient resided in into a category of high, medium, or low SES. Hazard ratios (HRs) were estimated using multivariate Cox proportional hazard models. After adjusting for age, gender, comorbidities, and histological subtypes, compared with MDS patients lived in high-SES census tracts, those resided in medium (HR = 1.14, 95% CI: 1.01–1.30) and low (HR = 1.17, 95% CI: 1.02–1.34) SES census tracts had significantly increased the risks of death. The impact of SES on survival was more apparent for patients with refractory anemia with ringed sideroblasts—patients residing in medium (HR = 1.85, 95% CI: 1.17–2.91) and low (HR = 2.06, 95% CI: 1.27–3.37) census tracts had a nearly two-fold increased the risk of mortality, compared with those living in high-SES census tracts. In conclusion, this population-based study suggests that neighborhood SES status is a significant and independent determinant of survival among elderly patients with MDS in the United States.

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Acknowledgments

This work was supported by a grant from the National Cancer Institute (K07 CA119108). Dr Gross’s efforts were supported by Beeson Career Development Award (1 K08 AG24842). The linked SEER–Medicare database was used for this study. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER–Medicare database.

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Authors and Affiliations

  1. Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College St, Box 208034, New Haven, CT, 06520-8034, USA

    Rong Wang & Xiaomei Ma

  2. Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    Cary P. Gross

  3. Section of Hematology, Yale University School of Medicine, New Haven, CT, USA

    Stephanie Halene

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  1. Rong Wang
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  2. Cary P. Gross
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  4. Xiaomei Ma
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Correspondence to Xiaomei Ma.

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Wang, R., Gross, C.P., Halene, S. et al. Neighborhood socioeconomic status influences the survival of elderly patients with myelodysplastic syndromes in the United States. Cancer Causes Control 20, 1369–1376 (2009). https://doi.org/10.1007/s10552-009-9362-7

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  • DOI: https://doi.org/10.1007/s10552-009-9362-7

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