Influence of Disadvantaged Socioeconomic and Demographic Status on Overall Survival in Patients with Kaposi Sarcoma
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Keywords
kaposi sarcoma, healthcare disparities, skin cancer, social determinants of health, National Cancer Database (NCDB)
Abstract
BACKGROUND: Kaposi sarcoma (KS) is a cutaneous and mucous membrane tumor caused by human/Kaposi sarcoma herpesvirus 8 (HHV-8), typically seen in immunocompromised patients, including those with HIV/AIDS. Patients from traditionally underserved and underrepresented (URM) populations have disparate survival outcomes across malignancies, however the effects of socioeconomic and demographic factors on survival have not been described on a large scale in KS.
METHODS: KS patients diagnosed from 2004-2017 were identified in the National Cancer Database (NCDB). Overall survival (OS) was analyzed using Kaplan Meier and adjusted Cox regression methods, and repeated in a propensity score matched cohort, where White patients were matched to Black patients 1:1 for demographic factors and comorbidities.
RESULTS: For the 4,034 identified patients, advanced age, Black race, HIV-positive status, and Charlson-Deyo score ≥1 were independently associated with decreased OS. Survival benefit was seen with Spanish/Hispanic ethnicity, private insurance, residence in areas of high educational attainment, and treatment at academic centers. Black patients had median survival of 99 months (95% confidence interval [CI] 73-124 months) compared to White patients (140 months, 95% CI 122-158 months) (p<0.001). Following propensity score matching, Black patients continued to have poorer OS compared to White patients (119 months versus 136 months, p=0.045).
CONCLUSION: We describe the impact of socioeconomic factors and race on survival in KS, finding significantly reduced survival in Black patients, which persisted after controlling for covariates. These results highlight the need for directed efforts promoting equitable outcomes for underrepresented minorities.
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