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Article: Neighborhood-level COVID vaccination and booster disparities: A population-level analysis across California.

Oh, Debora L / Kemper, Kathryn E / Meltzer, Dan / Canchola, Alison J / Bibbins-Domingo, Kirsten / Lyles, Courtney R

SSM - population health

2023 Volume 22, Page(s) 101366

Abstract: Objectives: To describe vaccine and booster uptake by neighborhood-level factors in California.: Methods: We examined trends in COVID-19 vaccination up to September 21, 2021, and boosters up to March 29, 2022 using data from the California Department ...

Abstract	Objectives: To describe vaccine and booster uptake by neighborhood-level factors in California. Methods: We examined trends in COVID-19 vaccination up to September 21, 2021, and boosters up to March 29, 2022 using data from the California Department of Public Health. Quasi-Poisson regression was used to model the association between neighborhood-level factors and fully vaccinated and boosted among ZIP codes. Sub-analyses on booster rates were compared among the 10 census regions. Results: In a minimally adjusted model, a higher proportion of Black residents was associated with lower vaccination (HR = 0.97; 95%CI: 0.96-0.98). However, in a fully adjusted model, proportion of Black, Hispanic/Latinx, and Asian residents were associated with higher vaccination rates (HR = 1.02; 95%CI: 1.01-1.03 for all). The strongest predictor of low vaccine coverage was disability (HR = 0.89; 95%CI: 0.86-0.91). Similar trends persisted for booster doses. Factors associated with booster coverage varied by region. Conclusions: Examining neighborhood-level factors associated with COVID-19 vaccination and booster rates uncovered significant variation within the large and geographically and demographically diverse state of California. Equity-based approaches to vaccination must ensure a robust consideration of multiple social determinants of health.
Language	English
Publishing date	2023-02-21
Publishing country	England
Document type	Journal Article
ISSN	2352-8273
ISSN	2352-8273
DOI	10.1016/j.ssmph.2023.101366
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Article: Changes in Cancer Mortality by Race and Ethnicity Following the Implementation of the Affordable Care Act in California.

Martinez, Maria Elena / Gomez, Scarlett L / Canchola, Alison J / Oh, Debora L / Murphy, James D / Mehtsun, Winta / Yabroff, K Robin / Banegas, Matthew P

Frontiers in oncology

2022 Volume 12, Page(s) 916167

Abstract: Although Affordable Care Act (ACA) implementation has improved cancer outcomes, less is known about how much the improvement applies to different racial and ethnic populations. We examined changes in health insurance coverage and cancer-specific ... ...

Abstract	Although Affordable Care Act (ACA) implementation has improved cancer outcomes, less is known about how much the improvement applies to different racial and ethnic populations. We examined changes in health insurance coverage and cancer-specific mortality rates by race/ethnicity pre- and post-ACA. We identified newly diagnosed breast (n = 117,738), colorectal (n = 38,334), and cervical cancer (n = 11,109) patients < 65 years in California 2007-2017. Hazard rate ratios (HRR) and 95% confidence intervals (CI) were calculated using multivariable Cox regression to estimate risk of cancer-specific death pre- (2007-2010) and post-ACA (2014-2017) and by race/ethnicity [American Indian/Alaska Natives (AIAN); Asian American; Hispanic; Native Hawaiian or Pacific Islander (NHPI); non-Hispanic Black (NHB); non-Hispanic white (NHW)]. Cancer-specific mortality from colorectal cancer was lower post-ACA among Hispanic (HRR = 0.82, 95% CI = 0.74 to 0.92), NHB (HRR = 0.69, 95% CI = 0.58 to 0.82), and NHW (HRR = 0.90; 95% CI = 0.84 to 0.97) but not Asian American (HRR = 0.95, 95% CI = 0.82 to 1.10) patients. We observed a lower risk of death from cervical cancer post-ACA among NHB women (HRR = 0.68, 95% CI = 0.47 to 0.99). No statistically significant differences in breast cancer-specific mortality were observed for any racial or ethnic group. Cancer-specific mortality decreased following ACA implementation for colorectal and cervical cancers for some racial and ethnic groups in California, suggesting Medicaid expansion is associated with reductions in health inequity.
Language	English
Publishing date	2022-07-13
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.916167
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Article ; Online: Disparities in cancer incidence by rurality in California.

Oh, Debora L / Schumacher, Karen / Yang, Juan / Wang, Katarina / Lin, Katherine / Gomez, Scarlett Lin / Shariff-Marco, Salma

Journal of the National Cancer Institute

2022 Volume 115, Issue 4, Page(s) 385–393

Abstract: Background: Cancer rates in rural areas across the United States have different patterns than in urban areas. This study examines associations between rurality and incidence for the top 5 cancers in California and evaluates whether these associations ... ...

Abstract	Background: Cancer rates in rural areas across the United States have different patterns than in urban areas. This study examines associations between rurality and incidence for the top 5 cancers in California and evaluates whether these associations vary jointly by sex, race, and ethnicity. Methods: We used 2015-2019 California Cancer Registry data to compare incidence rate ratios (IRRs) and trends for breast, prostate, lung, colorectal, and skin (melanoma) cancers. We leveraged census tract aggregation zones and 7 levels of percentage rural population (0%, >0% to <10%, 10% to <20%, 20% to <30%, 30% to <40%, 40% to <50%, and 50+%). Results: Zones with higher proportions of rural population were significantly associated with lower incidence of female breast cancer and prostate cancer, though the trends were not statistically significant overall. Zones with higher proportions of rural population were significantly associated with higher incidence of lung cancer and melanoma. There were no statistically significant trends for colorectal cancer overall. Comparing areas with 50% and over rural population with areas with 0% rural population, the IRR for lung cancer in Hispanic females was higher (IRR = 1.43, 95% confidence interval [CI] = 1.17 to 1.74) than in Hispanic males (IRR = 0.90, 95% CI = 0.72 to 1.11). Also, in areas with 50% or more rural population, the IRR for melanoma was higher in Hispanic females (IRR = 1.75, 95% CI = 1.23 to 2.45) than non-Hispanic White females (IRR = 0.87, 95% CI = 0.80 to 0.95). Conclusions: Our findings show that rurality is associated with cancer incidence and underscore the importance of jointly examining rural disparities with sex, race, and ethnicity by cancer site.
MeSH term(s)	Male ; Humans ; Female ; United States/epidemiology ; Incidence ; Rural Population ; Lung Neoplasms/epidemiology ; Melanoma/epidemiology ; California/epidemiology
Language	English
Publishing date	2022-12-30
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2992-0
ISSN	1460-2105 ; 0027-8874 ; 0198-0157
ISSN (online)	1460-2105
ISSN	0027-8874 ; 0198-0157
DOI	10.1093/jnci/djac238
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Article ; Online: Correlates of supportive care needs among Asian Americans with colorectal, liver, or lung cancer from a web-based patient navigation portal intervention: The Patient COUNTS study.

Wang, Katarina / Chu, Janet N / Oh, Debora L / Shariff-Marco, Salma / Allen, Laura / Kuo, Mei-Chin / Wong, Ching / Bui, Hoan / Chen, Junlin / Li, Feng Ming / Ma, Carmen / Truong, Angeline / Gomez, Scarlett L / Nguyen, Tung T / Tsoh, Janice Y

Cancer reports (Hoboken, N.J.)

2024 Volume 7, Issue 2, Page(s) e1971

Abstract: Background: Cancer is the leading cause of death among Asian Americans, who often face barriers to cancer care. Cancer supportive care needs among Asian Americans remain understudied.: Aims: We examined cancer supportive care needs and participant ... ...

Abstract	Background: Cancer is the leading cause of death among Asian Americans, who often face barriers to cancer care. Cancer supportive care needs among Asian Americans remain understudied. Aims: We examined cancer supportive care needs and participant factors correlated with these needs, identified profiles of supportive care needs, and examined whether needs profiles are associated with quality of life among Asian American adults. Methods and results: We recruited 47 Asian American adults with colorectal, liver, or lung cancer who spoke Chinese, English, or Vietnamese, and were starting or undergoing cancer treatment. We assessed cancer supportive care needs in four domains: cancer information, daily living, behavioral health, and language assistance. Hierarchical cluster analysis was used to identify clusters of participants based on their supportive need profiles to further examine the association between need profiles and quality of life (QoL) assessed by the Functional Assessment of Cancer Therapy. Participants (mean age = 57.6) included 72% males and 62% spoke English less than very well. Older participants (age ≥ 65) and those with annual income <$50K reported higher daily living needs. Men and younger participants (age < 50) reported higher behavioral health needs. We found three clusters displaying distinct cancer supportive need profiles: Cluster 1 (28% of the sample) displayed high needs across all domains; Cluster 2 (51%) had low needs across all domains; and Cluster 3 (21%) had high needs for cancer information and daily living. Cluster 1 participants reported the lowest QoL. Conclusion: Cancer supportive care needs among Asian American patients with colorectal, liver, and lung cancer were associated with patient characteristics and QoL. Understanding cancer supportive care needs will inform future interventions to improve care and QoL for Asian American patients with cancer. Clinicaltrials: gov Identifier: NCT03867916.
MeSH term(s)	Adult ; Female ; Humans ; Male ; Middle Aged ; Asian ; Colorectal Neoplasms/therapy ; Internet ; Lung Neoplasms/therapy ; Patient Navigation ; Quality of Life ; Liver Neoplasms/therapy ; Patient Portals
Language	English
Publishing date	2024-02-13
Publishing country	United States
Document type	Clinical Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2573-8348
ISSN (online)	2573-8348
DOI	10.1002/cnr2.1971
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Article ; Online: Disease burden of adverse childhood experiences across 14 states.

Waehrer, Geetha M / Miller, Ted R / Silverio Marques, Sara C / Oh, Debora L / Burke Harris, Nadine

PloS one

2020 Volume 15, Issue 1, Page(s) e0226134

Abstract: Objective: To examine whether the relationship between Adverse Childhood Experiences (ACEs) and health outcomes is similar across states and persists net of ACEs associations with smoking, heavy drinking, and obesity.: Methods: We use data from the ... ...

Abstract	Objective: To examine whether the relationship between Adverse Childhood Experiences (ACEs) and health outcomes is similar across states and persists net of ACEs associations with smoking, heavy drinking, and obesity. Methods: We use data from the Behavioral Risk Factor Surveillance System for 14 states. Logistic regressions yield estimates of the direct associations of ACEs exposure with health outcomes net of health risk factors, and indirect ACEs-health associations via health risk factors. Models were estimated for California (N = 22,475) and pooled data from 13 states (N = 110,076), and also separately by state. Results: Exposure to ACEs is associated with significantly higher odds of smoking, heavy drinking, and obesity. Net of these health risk factors, there was a significant and graded relationship in California and the pooled 13-state data between greater ACEs exposure and odds of depression, asthma, COPD, arthritis, and cardiovascular disease. Four or more ACEs were less consistently associated across states with cancer and diabetes and a dose-response relationship was also not present. There was a wide range across individual states in the percentage change in health outcomes predicted for exposure to 4+ ACEs. ACEs-related smoking, heavy drinking, and obesity explain a large and significant proportion of 4+ ACEs associations with COPD and cardiovascular disease, however some effect, absent of risk behavior, remained. Conclusions: ACE's associations with most of the health conditions persist independent of behavioral pathways but only asthma, arthritis, COPD, cardiovascular disease, and depression consistently exhibit a dose-response relationship. Our results suggest that attention to child maltreatment and household dysfunction, mental health treatment, substance abuse prevention and promotion of physical activity and healthy weight outcomes might mitigate some adverse health consequences of ACEs. Differences across states in the pattern of ACEs-health associations may also indicate fruitful areas for prevention.
MeSH term(s)	Adolescent ; Adult ; Adverse Childhood Experiences/statistics & numerical data ; Age Distribution ; Aged ; Child ; Disease/psychology ; Epidemiology ; Female ; Humans ; Male ; Middle Aged ; Models, Statistical ; Prevalence ; Probability ; Risk Factors ; Sex Distribution ; Young Adult
Language	English
Publishing date	2020-01-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0226134
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Article ; Online: Integration of electronic pathology reporting with clinical trial matching for advanced prostate cancer.

Borno, Hala T / Duffy, Christine / Zhang, Sylvia / Canchola, Alison J / Loya, Zinnia / Golden, Todd / Oh, Debora L / Odisho, Anobel Y / Gomez, Scarlett

Urologic oncology

2021 Volume 39, Issue 8, Page(s) 494.e7–494.e14

Abstract: Introduction: Racial/ethnic diversity in prostate cancer (CaP) clinical trials (CTs) is essential to address CaP disparities. California Cancer Registry mandated electronic reporting (e-path) of structured data elements from pathologists diagnosing ... ...

Abstract	Introduction: Racial/ethnic diversity in prostate cancer (CaP) clinical trials (CTs) is essential to address CaP disparities. California Cancer Registry mandated electronic reporting (e-path) of structured data elements from pathologists diagnosing cancer thereby creating an opportunity to identify and approach patients rapidly. This study tested the utility of an online CT matching tool (called Trial Library) used in combination with e-path to improve matching of underrepresented CaP patients into CTs at time of diagnosis. Methods: This was a nonrandomized, single-arm feasibility study among patients with a new pathologic diagnosis of high-risk CaP (Gleason Score ≥8). Eligible patients were sent recruitment materials and enrolled patients were introduced to Trial Library. Results: A total of 419 case listings were assessed. Patients were excluded due to physician contraindication, not meeting baseline eligibility, or unable to be reached. Final participants (N = 52) completed a baseline survey. Among study participants, 77% were White, 10% were Black/Hispanic/Missing, and 14% were Asian. The majority of the study participants were over 65 years of age (81%) and Medicare insured (62%). Additionally, 81% of participants reported using the Internet to learn about CaP. The majority (62%) of participants reported that Trial Library increased their interest in CT participation. Conclusions: The current study demonstrated that leveraging structured e-path data reporting to a population-based cancer registry to recruit men with high risk CaP to clinical research is feasible and acceptable. We observed that e-path may be linked with an online CT matching tool, Trial Library. Future studies will prioritize recruitment from reporting facilities that serve more racially/ethnically diverse patient populations.
MeSH term(s)	Aged ; Aged, 80 and over ; Clinical Trials as Topic/statistics & numerical data ; Electronic Health Records/statistics & numerical data ; Ethnicity/statistics & numerical data ; Feasibility Studies ; Follow-Up Studies ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Middle Aged ; Non-Randomized Controlled Trials as Topic ; Pathology, Clinical/methods ; Patient Selection ; Prognosis ; Prostatic Neoplasms/pathology ; Racial Groups/statistics & numerical data
Language	English
Publishing date	2021-01-05
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1336505-8
ISSN	1873-2496 ; 1078-1439
ISSN (online)	1873-2496
ISSN	1078-1439
DOI	10.1016/j.urolonc.2020.12.010
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Article ; Online: Groundwater constituents and the incidence of kidney cancer.

Soerensen, Simon John Christoph / Montez-Rath, Maria E / Cheng, Iona / Gomez, Scarlett Lin / Oh, Debora L / Jackson, Christian / Li, Jinhui / Rehkopf, David / Chertow, Glenn M / Langston, Marvin E / Ganesan, Calyani / Pao, Alan C / Chung, Benjamin I / Leppert, John T

Cancer

2023 Volume 129, Issue 20, Page(s) 3309–3317

Abstract: Background: Kidney cancer incidence demonstrates significant geographic variation suggesting a role for environmental risk factors. This study sought to evaluate associations between groundwater exposures and kidney cancer incidence.: Methods: The ... ...

Abstract	Background: Kidney cancer incidence demonstrates significant geographic variation suggesting a role for environmental risk factors. This study sought to evaluate associations between groundwater exposures and kidney cancer incidence. Methods: The authors identified constituents from 18,506 public groundwater wells in all 58 California counties measured in 1996-2010, and obtained county-level kidney cancer incidence data from the California Cancer Registry for 2003-2017. The authors developed a water-wide association study (WWAS) platform using XWAS methodology. Three cohorts were created with 5 years of groundwater measurements and 5-year kidney cancer incidence data. The authors fit Poisson regression models in each cohort to estimate the association between county-level average constituent concentrations and kidney cancer, adjusting for known risk factors: sex, obesity, smoking prevalence, and socioeconomic status at the county level. Results: Thirteen groundwater constituents met stringent WWAS criteria (a false discovery rate <0.10 in the first cohort, followed by p values <.05 in subsequent cohorts) and were associated with kidney cancer incidence. The seven constituents directly related to kidney cancer incidence (and corresponding standardized incidence ratios) were chlordane (1.06; 95% confidence interval [CI], 1.02-1.10), dieldrin (1.04; 95% CI, 1.01-1.07), 1,2-dichloropropane (1.04; 95% CI, 1.02-1.05), 2,4,5-TP (1.03; 95% CI, 1.01-1.05), glyphosate (1.02; 95% CI, 1.01-1.04), endothall (1.02; 95% CI, 1.01-1.03), and carbaryl (1.02; 95% CI, 1.01-1.03). Among the six constituents inversely related to kidney cancer incidence, the standardized incidence ratio furthest from the null was for bromide (0.97; 95% CI, 0.94-0.99). Conclusions: This study identified several groundwater constituents associated with kidney cancer. Public health efforts to reduce the burden of kidney cancer should consider groundwater constituents as environmental exposures that may be associated with the incidence of kidney cancer.
MeSH term(s)	Humans ; Incidence ; Groundwater ; Environmental Exposure/adverse effects ; Carcinoma, Renal Cell ; Kidney Neoplasms/epidemiology
Language	English
Publishing date	2023-06-07
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1429-1
ISSN	1097-0142 ; 0008-543X ; 1934-662X
ISSN (online)	1097-0142
ISSN	0008-543X ; 1934-662X
DOI	10.1002/cncr.34898
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Article ; Online: Asian American Women's Experiences of Discrimination and Health Behaviors during the COVID-19 Pandemic.

Wang, Katarina / Guan, Alice / Seto, Janice / Oh, Debora L / Lau, Kathie / Duffy, Christine / Castillo, Esperanza / McGuire, Valerie / Wadhwa, Michelle / Tepper, Clifford G / Wakelee, Heather A / DeRouen, Mindy C / Shariff-Marco, Salma / Cheng, Iona / Gomez, Scarlett Lin

Journal of immigrant and minority health

2023 Volume 26, Issue 2, Page(s) 421–425

Abstract: The COVID-19 pandemic exacerbated racism experienced by Asian Americans, especially women and older individuals. Little is known about how discriminatory experiences during the pandemic have influenced health behaviors among Asian Americans. Between 10/ ... ...

Abstract	The COVID-19 pandemic exacerbated racism experienced by Asian Americans, especially women and older individuals. Little is known about how discriminatory experiences during the pandemic have influenced health behaviors among Asian Americans. Between 10/2021 and 6/2022, we surveyed 193 Asian American women in the San Francisco area. Participants were asked to report types of discrimination they experienced since March 2020. We explored bivariable associations of discrimination and changes in health behaviors and healthcare utilization. Most women were Chinese American (75%) and over 45-years-old (87%). The top three discriminatory experiences reported were being treated with less respect (60%), being treated unfairly at restaurants/stores (49%), and people acting as if they are better (47%). Chinese American women (vs. non-Chinese Asian American women) reported higher frequencies of being threatened/harassed (40% vs. 22%). Women who reported any discriminatory experience (vs. none) were more likely to report less physical exercise (42.7% vs. 26.3%) and canceling/rescheduling medical appointments (65.0% vs. 45.1%). Our findings begin to elucidate Asian American women's experiences of discrimination since the pandemic and provide evidence of the harmful impacts of anti-Asian racism on health behaviors.
MeSH term(s)	Humans ; Female ; Middle Aged ; Asian ; COVID-19 ; Pandemics ; Health Behavior ; Exercise ; Racism
Language	English
Publishing date	2023-10-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2220162-2
ISSN	1557-1920 ; 1557-1912
ISSN (online)	1557-1920
ISSN	1557-1912
DOI	10.1007/s10903-023-01558-2
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Article ; Online: Neighborhood Factors Associated with COVID-19 Cases in California.

Oh, Debora L / Meltzer, Dan / Wang, Katarina / Canchola, Alison J / DeRouen, Mindy C / McDaniels-Davidson, Corinne / Gibbons, Joseph / Carvajal-Carmona, Luis / Nodora, Jesse N / Hill, Linda / Gomez, Scarlett Lin / Martinez, Maria Elena

Journal of racial and ethnic health disparities

2022 Volume 10, Issue 6, Page(s) 2653–2662

Abstract: Background: There is a need to assess neighborhood-level factors driving COVID-19 disparities across racial and ethnic groups.: Objective: To use census tract-level data to investigate neighborhood-level factors contributing to racial and ethnic ... ...

Abstract	Background: There is a need to assess neighborhood-level factors driving COVID-19 disparities across racial and ethnic groups. Objective: To use census tract-level data to investigate neighborhood-level factors contributing to racial and ethnic group-specific COVID-19 case rates in California. Design: Quasi-Poisson generalized linear models were used to identify neighborhood-level factors associated with COVID-19 cases. In separate sequential models for Hispanic, Black, and Asian, we characterized the associations between neighborhood factors on neighborhood COVID-19 cases. Subanalyses were conducted on neighborhoods with majority Hispanic, Black, and Asian residents to identify factors that might be unique to these neighborhoods. Geographically weighted regression using a quasi-Poisson model was conducted to identify regional differences. Main measures: All COVID-19 cases and tests reported through January 31, 2021, to the California Department of Public Health. Neighborhood-level data from census tracts were obtained from American Community Survey 5-year estimates (2015-2019), United States Census (2010), and United States Department of Housing and Urban Development. Key results: The neighborhood factors associated with COVID-19 case rate were racial and ethnic composition, age, limited English proficiency (LEP), income, household size, and population density. LEP had the largest influence on the positive association between proportion of Hispanic residents and COVID-19 cases (- 2.1% change). This was also true for proportion of Asian residents (- 1.8% change), but not for the proportion of Black residents (- 0.1% change). The influence of LEP was strongest in areas of the Bay Area, Los Angeles, and San Diego. Conclusion: Neighborhood-level contextual drivers of COVID-19 burden differ across racial and ethnic groups.
MeSH term(s)	Humans ; United States ; COVID-19/epidemiology ; Ethnicity ; Residence Characteristics ; Racial Groups ; California/epidemiology ; Los Angeles ; Socioeconomic Factors
Language	English
Publishing date	2022-11-14
Publishing country	Switzerland
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2760524-3
ISSN	2196-8837 ; 2197-3792
ISSN (online)	2196-8837
ISSN	2197-3792
DOI	10.1007/s40615-022-01443-y
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Article ; Online: Impact of the Patient Protection and Affordable Care Act on 1-year survival in glioblastoma patients.

Moghavem, Nuriel / Oh, Debora L / Santiago-Rodríguez, Eduardo J / Tate, William J / Gomez, Scarlett Lin / Thomas, Reena

Neuro-oncology advances

2020 Volume 2, Issue 1, Page(s) vdaa080

Abstract: Background: Glioblastoma (GBM) treatment requires access to complex medical services, and the Patient Protection and Affordable Care Act (ACA) sought to expand access to health care, including complex oncologic care. Whether the implementation of the ... ...

Abstract	Background: Glioblastoma (GBM) treatment requires access to complex medical services, and the Patient Protection and Affordable Care Act (ACA) sought to expand access to health care, including complex oncologic care. Whether the implementation of the ACA was subsequently associated with changes in 1-year survival in GBM is not known. Methods: A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database. We identified patients with the primary diagnosis of GBM between 2008 and 2016. A multivariable-adjusted Cox proportional hazards model was developed using patient and clinical characteristics to determine the main outcome: the 1-year cumulative probability of death by state expansion status. Results: A total of 25 784 patients and 14 355 deaths at 1 year were identified and included in the analysis, 49.7% were older than 65 at diagnosis. Overall 1-year cumulative probability of death for GBM patients in non-expansion versus expansion states did not significantly worsen over the 2 time periods (2008-2010: hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.04-1.19; 2014-2016: HR 1.18, 95% CI 1.09-1.27). In GBM patients younger than age 65 at diagnosis, there was a nonsignificant trend toward the poorer 1-year cumulative probability of death in non-expansion versus expansion states (2008-2010: HR 1.09, 95% CI 0.97-1.22; 2014-2016: HR 1.23, 95% CI 1.09-1.40). Conclusions: No differences were found over time in survival for GBM patients in expansion versus non-expansion states. Further study may reveal whether GBM patients diagnosed younger than age 65 in expansion states experienced improvements in 1-year survival.
Language	English
Publishing date	2020-06-19
Publishing country	England
Document type	Journal Article
ZDB-ID	3009682-0
ISSN	2632-2498 ; 2632-2498
ISSN (online)	2632-2498
ISSN	2632-2498
DOI	10.1093/noajnl/vdaa080
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