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Socioeconomic Status, Not Race, Is Associated With Reduced Survival in Esophagectomy Patients.

Publication ,  Journal Article
Erhunmwunsee, L; Gulack, BC; Rushing, C; Niedzwiecki, D; Berry, MF; Hartwig, MG
Published in: Ann Thorac Surg
July 2017

BACKGROUND: Black patients with esophageal cancer have worse survival than white patients. This study examines this racial disparity in conjunction with socioeconomic status (SES) and explores whether race-based outcome differences exist using a national database. METHODS: The associations between race and SES with overall survival of patients treated with esophagectomy for stages I to III esophageal cancer between 2003 and 2011 in the National Cancer Data Base were investigated using the Kaplan-Meier method and proportional hazards analyses. Median income by zip code and proportion of the zip code residents without a high school diploma were grouped into income and education quartiles, respectively and used as surrogates for SES. The association between race and overall survival stratified by SES is explored. RESULTS: Of 11,599 esophagectomy patients who met study criteria, 3,503 (30.2%) were in the highest income quartile, 2,847 (24.5%) were in the highest education quartile, and 610 patients (5%) were black. Before adjustment for SES, black patients had worse overall survival than white patients (median survival 23.0 versus 34.7 months, log rank p < 0.001), and overall, survival times improved with increasing income and education (p < 0.001 for both). After adjustment for putative prognostic factors, SES was associated with overall survival, whereas race was not. CONCLUSIONS: Prior studies have suggested that survival of esophageal cancer patients after esophagectomy is associated with race. Our study suggests that race is not significantly related to overall survival when adjusted for other prognostic variables. Socioeconomic status, however, remains significantly related to overall survival in our model.

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Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

July 2017

Volume

104

Issue

1

Start / End Page

234 / 244

Location

Netherlands

Related Subject Headings

  • Young Adult
  • United States
  • Survival Rate
  • Socioeconomic Factors
  • Social Class
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Racial Groups
  • Prognosis
 

Citation

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Erhunmwunsee, L., Gulack, B. C., Rushing, C., Niedzwiecki, D., Berry, M. F., & Hartwig, M. G. (2017). Socioeconomic Status, Not Race, Is Associated With Reduced Survival in Esophagectomy Patients. Ann Thorac Surg, 104(1), 234–244. https://doi.org/10.1016/j.athoracsur.2017.01.049
Erhunmwunsee, Loretta, Brian C. Gulack, Christel Rushing, Donna Niedzwiecki, Mark F. Berry, and Matthew G. Hartwig. “Socioeconomic Status, Not Race, Is Associated With Reduced Survival in Esophagectomy Patients.Ann Thorac Surg 104, no. 1 (July 2017): 234–44. https://doi.org/10.1016/j.athoracsur.2017.01.049.
Erhunmwunsee L, Gulack BC, Rushing C, Niedzwiecki D, Berry MF, Hartwig MG. Socioeconomic Status, Not Race, Is Associated With Reduced Survival in Esophagectomy Patients. Ann Thorac Surg. 2017 Jul;104(1):234–44.
Erhunmwunsee, Loretta, et al. “Socioeconomic Status, Not Race, Is Associated With Reduced Survival in Esophagectomy Patients.Ann Thorac Surg, vol. 104, no. 1, July 2017, pp. 234–44. Pubmed, doi:10.1016/j.athoracsur.2017.01.049.
Erhunmwunsee L, Gulack BC, Rushing C, Niedzwiecki D, Berry MF, Hartwig MG. Socioeconomic Status, Not Race, Is Associated With Reduced Survival in Esophagectomy Patients. Ann Thorac Surg. 2017 Jul;104(1):234–244.

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

July 2017

Volume

104

Issue

1

Start / End Page

234 / 244

Location

Netherlands

Related Subject Headings

  • Young Adult
  • United States
  • Survival Rate
  • Socioeconomic Factors
  • Social Class
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Racial Groups
  • Prognosis