Racial Disparities in Children, Adolescents, and Young Adults with Hodgkin Lymphoma Enrolled in the New York State Medicaid Program.

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  • Additional Information
    • Source:
      Publisher: Mary Ann Liebert, Inc Country of Publication: United States NLM ID: 101543508 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2156-535X (Electronic) Linking ISSN: 21565333 NLM ISO Abbreviation: J Adolesc Young Adult Oncol Subsets: MEDLINE
    • Publication Information:
      Original Publication: New Rochelle, NY : Mary Ann Liebert, Inc.
    • Subject Terms:
      Hodgkin Disease*; Adolescent ; Child ; Cohort Studies ; Humans ; Medicaid ; New York/epidemiology ; Proportional Hazards Models ; United States/epidemiology ; Young Adult
    • Abstract:
      Background: We examined the impact of race/ethnicity and age on survival in a publicly insured cohort of children and adolescent/young adults (AYA; 15-39 years) with Hodgkin lymphoma, adjusting for chemotherapy using linked Medicaid claims. Materials and Methods: We identified 1231 Medicaid-insured patients <1-39 years diagnosed with classical Hodgkin lymphoma between 2005 and 2015, in the New York State Cancer Registry. Chemotherapy regimens were based on contemporary therapeutic regimens. Cox proportional hazards regression models quantified associations of patient, disease, and treatment variables with overall survival (OS) and disease-specific survival (DSS), and are presented as hazard ratios (HR) with confidence intervals (95% CIs). Results: At median follow-up of 6.6 years, N  = 1108 (90%) patients were alive; 5-year OS was 92% in children <15 years. In multivariable models, Black (vs. White) patients had 1.6-fold increased risk of death (HR: 1.58, 95% CI: 1.02-2.46; p  = 0.042). Stage III/IV (vs. I/II) was associated with 1.9-fold increased risk of death (HR: 1.86, 95% CI: 1.25-2.78; p  = 0.002) and treatment at a non-National Cancer Institute (NCI) affiliate was associated with worse DSS (HR: 2.71, 95% CI: 1.47-4.98; p  = 0.001). Conclusions: In this Medicaid-insured cohort of children and AYAs with Hodgkin lymphoma, Black race/ethnicity remained associated with inferior OS in multivariable models adjusted for disease, demographic, and treatment data. Further work is needed to identify dimensions of health care access not mediated by insurance, as findings suggest additional factors are contributing to observed cancer disparities in vulnerable pediatric and AYA populations.
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    • Grant Information:
      KL2 TR001874 United States TR NCATS NIH HHS
    • Contributed Indexing:
      Keywords: AYA; Hodgkin lymphoma; Medicaid; disparities; pediatric; race/ethnicity
    • Publication Date:
      Date Created: 20211012 Date Completed: 20220818 Latest Revision: 20230802
    • Publication Date:
      20240105
    • Accession Number:
      PMC9419970
    • Accession Number:
      10.1089/jayao.2021.0131
    • Accession Number:
      34637625