Effects of socioeconomic status on cancer patient survival: counterfactual event-based mediation analysis
- PDF / 1,558,051 Bytes
- 11 Pages / 595.276 x 790.866 pts Page_size
- 29 Downloads / 205 Views
ORIGINAL PAPER
Effects of socioeconomic status on cancer patient survival: counterfactual event-based mediation analysis Shi‑Woei Lin1,2 · Kartika Nur Anisa1 Received: 14 December 2019 / Accepted: 22 October 2020 © Springer Nature Switzerland AG 2020
Abstract Purpose This study investigated the direct and indirect effects of socioeconomic status (SES) on the survival time of cancer patients by using cancer stage to create a pathway from SES to health outcomes and facilitate a mechanistic inference. Methods Both a traditional mediation analysis and a counterfactual event-based mediation analysis were applied to SEER (The Surveillance, Epidemiology, and End Results) data from the National Cancer Institute of the United States. A Cox proportional hazards model for survival analysis was performed in the mediation analysis. Results The counterfactual event-based mediation analysis showed that the effect of SES on survival time was partially mediated by stage at diagnosis in lung (12%), liver (14.33%), and colorectal (9%) cancers. Investigation of the fundamental mechanism involved thus established the direct effect of SES on survival time and the indirect effect of SES on survival time through stage at diagnosis. Moreover, the mediation analysis also revealed that the disparity in timely diagnosis (i.e., stage at diagnosis) caused by SES was slightly significant. Conclusions SES can either affect cancer survival directly or indirectly through stage at diagnosis. Opportunities to reduce cancer disparity exist in the design of early detection policies or mechanisms for patients with varying resources. Keywords Cancer survival · Cox model · Mediation analysis · SEER
Introduction Approximately 9.5 million deaths in 2018 were attributable to cancer, of which lung cancer was the leading cause [1]. Other cancers with high mortality rates are liver, colorectal, stomach, breast, pancreas, esophagus, and prostate cancers [1]. Eradicating the burden of cancer and improving survival rates among cancer patients are therefore vital issues that need to be addressed by policy makers in the field of health care. One critical factor that needs to be explored through cancer research is the length of time cancer patients can survive from the time of diagnosis to death, also known as survival time. The medical condition of a patient and the treatment they receive are among the factors that have a critical influence * Kartika Nur Anisa [email protected] 1
Department of Industrial Management, National Taiwan University of Science and Technology, Taipei, Taiwan
Artificial Intelligence for Operations Management Research Center, National Taiwan University of Science and Technology, Taipei, Taiwan
2
on survival time. However, socioeconomic conditions or the social economic status of a patient can also influence the prognosis of the disease. Over the last few years, several research studies have shown that poor socioeconomic status can have negative effects on cancer patient survival. For example, Kuhn et al. [2] found
Data Loading...
