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Individual- and Neighborhood-Level Predictors of Mortality in Florida Colorectal Cancer Patients

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  • Stacey L Tannenbaum
  • Monique Hernandez
  • D Dandan Zheng
  • Daniel A Sussman
  • David J Lee

Abstract

Purpose: We examined individual-level and neighborhood-level predictors of mortality in CRC patients diagnosed in Florida to identify high-risk groups for targeted interventions. Methods: Demographic and clinical data from the Florida Cancer Data System registry (2007–2011) were linked with Agency for Health Care Administration and US Census data (n = 47,872). Cox hazard regression models were fitted with candidate predictors of CRC survival and stratified by age group (18–49, 50–64, 65+). Results: Stratified by age group, higher mortality risk per comorbidity was found among youngest (21%), followed by middle (19%), and then oldest (14%) age groups. The two younger age groups had higher mortality risk with proximal compared to those with distal cancer. Compared with private insurance, those in the middle age group were at higher death risk if not insured (HR = 1.35), or received healthcare through Medicare (HR = 1.44), Medicaid (HR = 1.53), or the Veteran’s Administration (HR = 1.26). Only Medicaid in the youngest (52% higher risk) and those not insured in the oldest group (24% lower risk) were significantly different from their privately insured counterparts. Among 18–49 and 50–64 age groups there was a higher mortality risk among the lowest SES (1.17- and 1.23-fold higher in the middle age and 1.12- and 1.17-fold higher in the older age group, respectively) compared to highest SES. Married patients were significantly better off than divorced/separated (HR = 1.22), single (HR = 1.29), or widowed (HR = 1.19) patients. Conclusion: Factors associated with increased risk for mortality among individuals with CRC included being older, uninsured, unmarried, more comorbidities, living in lower SES neighborhoods, and diagnosed at later disease stage. Higher risk among younger patients was attributed to proximal cancer site, Medicaid, and distant disease; however, lower SES and being unmarried were not risk factors in this age group. Targeted interventions to improve survivorship and greater social support while considering age classification may assist these high-risk groups.

Suggested Citation

  • Stacey L Tannenbaum & Monique Hernandez & D Dandan Zheng & Daniel A Sussman & David J Lee, 2014. "Individual- and Neighborhood-Level Predictors of Mortality in Florida Colorectal Cancer Patients," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-10, August.
    • Handle: RePEc:plo:pone00:0106322
    DOI: 10.1371/journal.pone.0106322
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    References listed on IDEAS

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    1. Krieger, N., 1992. "Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology," American Journal of Public Health, American Public Health Association, vol. 82(5), pages 703-710.
    2. Roetzheim, R.G. & Pal, N. & Gonzalez, E.C. & Ferrante, J.M. & Van Durme, D.J. & Krischer, J.P., 2000. "Effects of health insurance and race on colorectal cancer treatments and outcomes," American Journal of Public Health, American Public Health Association, vol. 90(11), pages 1746-1754.
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    1. Shannon M Lynch & Elizabeth Handorf & Kristen A Sorice & Elizabeth Blackman & Lisa Bealin & Veda N Giri & Elias Obeid & Camille Ragin & Mary Daly, 2020. "The effect of neighborhood social environment on prostate cancer development in black and white men at high risk for prostate cancer," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-18, August.

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