Cancer-directed surgery is the principal therapy for solid tumors. One-month mortality after surgery remains an important criterion for evaluating the quality of surgical treatment. Socioeconomic factors play important roles in the modern biopsychosocial medical model. Here we studied the relationship between socioeconomic factors and one-month mortality after surgery in 17 primary solid tumors.
Based on the Surveillance, Epidemiology, and End Results database between 2004 and 2014, we focused on the socioeconomic factors, containing ethnicity, marital status, insurance status, household income, educational level, residence, unemployment level, and poverty level. The top 17 common cancer sites were selected, including bladder, breast, cervix, colorectum, esophagus, kidney, liver, lung, melanoma, oral cavity, ovary, pancreas, small intestine, stomach, testis, thyroid, uterine. The primary outcome was that patients died within one month after surgery. The control group was patients surviving beyond one month. We performed multivariable logistic regression model and subgroup analysis to detect the association.
There were 24,233 (1.6%) patients dying within one month after surgery among 1,550,375 persons with primary solid cancers. Adjusted by age, gender and stage, patients with a unmarried state (aOR [adjusted odds ratio] 1.550, 95% CI [confidence interval] 1.504-1.597), Medicaid/uninsured (aOR 1.563, 95% CI 1.491-1.639), a low-income level (aOR 1.100, 95% CI 1.044-1.158), a low educational level (aOR 1.107, 95% CI 1.061-1.155), or a high poverty level (aOR 1.089, 95% CI 1.041-1.140), had significantly high risks of one-month mortality (All p values < 0.001). No significant association was found as for ethnicity, residence or unemployment. In the subgroup analysis by different cancer sites, it was found that the effects of the above-mentioned factors on mortality were almost consistent with overall.
Socioeconomically disadvantaged people tend to have high risks of one-month mortality after cancer-directed surgery. Especially in patients with unmarried or Medicaid/uninsured status, the risks were much higher than other factors.
Wei Sun.
Has not received any funding.
All authors have declared no conflicts of interest.