Neighborhood-level deprivation and survival in lung cancer.


Journal

BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800

Informations de publication

Date de publication:
06 Aug 2024
Historique:
received: 28 05 2024
accepted: 29 07 2024
medline: 7 8 2024
pubmed: 7 8 2024
entrez: 6 8 2024
Statut: epublish

Résumé

Despite recent advances in lung cancer therapeutics and improving overall survival, disparities persist among socially disadvantaged populations. This study aims to determine the effects of neighborhood deprivation indices (NDI) on lung cancer mortality. This is a multicenter retrospective cohort study assessing the relationship between NDI and overall survival adjusted for age, disease stage, and DNA methylation among biopsy-proven lung cancer patients. State-specific NDI for each year of sample collection were computed at the U.S. census tract level and dichotomized into low- and high-deprivation. A total of 173 non small lung cancer patients were included, with n = 85 (49%) and n = 88 (51%) in the low and high-deprivation groups, respectively. NDI was significantly higher among Black patients when compared with White patients (p = 0.003). There was a significant correlation between DNA methylation and stage for HOXA7, SOX17, ZFP42, HOXA9, CDO1 and TAC1. Only HOXA7 DNA methylation was positively correlated with NDI. The high-deprivation group had a statistically significant shorter survival than the low-deprivation group (p = 0.02). After adjusting for age, race, stage, and DNA methylation status, belonging to the high-deprivation group was associated with higher mortality with a hazard ratio of 1.81 (95%CI: 1.03-3.19). Increased neighborhood-level deprivation may be associated with liquid biopsy DNA methylation, shorter survival, and increased mortality. Changes in health care policies that consider neighborhood-level indices of socioeconomic deprivation may enable a more equitable increase in lung cancer survival.

Sections du résumé

BACKGROUND BACKGROUND
Despite recent advances in lung cancer therapeutics and improving overall survival, disparities persist among socially disadvantaged populations. This study aims to determine the effects of neighborhood deprivation indices (NDI) on lung cancer mortality. This is a multicenter retrospective cohort study assessing the relationship between NDI and overall survival adjusted for age, disease stage, and DNA methylation among biopsy-proven lung cancer patients. State-specific NDI for each year of sample collection were computed at the U.S. census tract level and dichotomized into low- and high-deprivation.
RESULTS RESULTS
A total of 173 non small lung cancer patients were included, with n = 85 (49%) and n = 88 (51%) in the low and high-deprivation groups, respectively. NDI was significantly higher among Black patients when compared with White patients (p = 0.003). There was a significant correlation between DNA methylation and stage for HOXA7, SOX17, ZFP42, HOXA9, CDO1 and TAC1. Only HOXA7 DNA methylation was positively correlated with NDI. The high-deprivation group had a statistically significant shorter survival than the low-deprivation group (p = 0.02). After adjusting for age, race, stage, and DNA methylation status, belonging to the high-deprivation group was associated with higher mortality with a hazard ratio of 1.81 (95%CI: 1.03-3.19).
CONCLUSIONS CONCLUSIONS
Increased neighborhood-level deprivation may be associated with liquid biopsy DNA methylation, shorter survival, and increased mortality. Changes in health care policies that consider neighborhood-level indices of socioeconomic deprivation may enable a more equitable increase in lung cancer survival.

Identifiants

pubmed: 39107707
doi: 10.1186/s12885-024-12720-w
pii: 10.1186/s12885-024-12720-w
doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

959

Informations de copyright

© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

Références

Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024. CA: Cancer J Clin 2024.
SEER Cancer Statistics Review (CSR.) 1975–2018 [ https://seer.cancer.gov/csr/1975_2018/]
Diez Roux AV. Investigating neighborhood and area effects on health. Am J Public Health. 2001;91(11):1783–9.
pubmed: 11684601 pmcid: 1446876 doi: 10.2105/AJPH.91.11.1783
Cockerham WC, Hamby BW, Oates GR. The Social determinants of Chronic Disease. Am J Prev Med. 2017;52(1S1):S5–12.
pubmed: 27989293 pmcid: 5328595 doi: 10.1016/j.amepre.2016.09.010
Galiatsatos P, Woo H, Paulin LM, Kind A, Putcha N, Gassett AJ, Cooper CB, Dransfield MT, Parekh TM, Oates GR, et al. The Association between Neighborhood Socioeconomic Disadvantage and Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2020;15:981–93.
pubmed: 32440110 pmcid: 7211318 doi: 10.2147/COPD.S238933
Singh GK, Jemal A. Socioeconomic and Racial/Ethnic disparities in Cancer Mortality, incidence, and Survival in the United States, 1950–2014: over six decades of changing patterns and widening inequalities. J Environ Public Health 2017, 2017:2819372.
Adie Y, Kats DJ, Tlimat A, Perzynski A, Dalton J, Gunzler D, Tarabichi Y. Neighborhood Disadvantage and Lung Cancer incidence in ever-smokers at a Safety Net Health-Care System: a retrospective study. Chest. 2020;157(4):1021–9.
pubmed: 31862438 doi: 10.1016/j.chest.2019.11.033
Hulbert A, Jusue-Torres I, Stark A, Chen C, Rodgers K, Lee B, Griffin C, Yang A, Huang P, Wrangle J, et al. Early detection of Lung Cancer using DNA promoter hypermethylation in plasma and Sputum. Clin Cancer Res. 2017;23(8):1998–2005.
pubmed: 27729459 doi: 10.1158/1078-0432.CCR-16-1371
Liu B, Ricarte Filho J, Mallisetty A, Villani C, Kottorou A, Rodgers K, Chen C, Ito T, Holmes K, Gastala N, et al. Detection of promoter DNA methylation in urine and plasma aids the detection of Non-small Cell Lung Cancer. Clin Cancer Res. 2020;26(16):4339–48.
pubmed: 32430478 pmcid: 7442601 doi: 10.1158/1078-0432.CCR-19-2896
Ettinger DS, Wood DE, Aisner DL, Akerley W, Bauman JR, Bharat A, Bruno DS, Chang JY, Chirieac LR, DeCamp M, et al. NCCN Guidelines(R) Insights: Non-small Cell Lung Cancer, Version 2.2023. J Natl Compr Canc Netw. 2023;21(4):340–50.
pubmed: 37015337 doi: 10.6004/jnccn.2023.0020
Haiman CA, Stram DO, Wilkens LR, Pike MC, Kolonel LN, Henderson BE, Le Marchand L. Ethnic and racial differences in the smoking-related risk of lung cancer. N Engl J Med. 2006;354(4):333–42.
pubmed: 16436765 doi: 10.1056/NEJMoa033250
DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African americans, 2019. CA Cancer J Clin. 2019;69(3):211–33.
doi: 10.3322/caac.21555
Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97(7):1283–9.
pubmed: 17538069 pmcid: 1913079 doi: 10.2105/AJPH.2005.080762
Mullins MA, Peres LC, Alberg AJ, Bandera EV, Barnholtz-Sloan JS, Bondy ML, Funkhouser E, Moorman PG, Peters ES, Terry PD, et al. Perceived discrimination, trust in physicians, and prolonged symptom duration before ovarian cancer diagnosis in the African American Cancer Epidemiology Study. Cancer. 2019;125(24):4442–51.
pubmed: 31415710 doi: 10.1002/cncr.32451
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S. The strengthening the reporting of Observational studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.
doi: 10.1016/S0140-6736(07)61602-X
R Core Team. In: Vienna, editor. R: a Language and Environment for Statistical Computing. Austria: R Foundation for Statistical Computing; 2022.
Budler ID. Ndi: Neighborhood Deprivation Indices. The Comprehensive R Archive Network 2022, v0.1.2.
Messer LC, Laraia BA, Kaufman JS, Eyster J, Holzman C, Culhane J, Elo I, Burke JG, O’Campo P. The development of a standardized neighborhood deprivation index. J Urban Health. 2006;83(6):1041–62.
pubmed: 17031568 pmcid: 3261293 doi: 10.1007/s11524-006-9094-x
Andrews MR, Tamura K, Claudel SE, Xu S, Ceasar JN, Collins BS, Langerman S, Mitchell VM, Baumer Y, Powell-Wiley TM. Geospatial analysis of Neighborhood Deprivation Index (NDI) for the United States by County. J Maps. 2020;16(1):101–12.
pubmed: 32855653 pmcid: 7447192 doi: 10.1080/17445647.2020.1750066
Slotman BA, Stinchcomb DG, Powell-Wiley TM, Ostendorf DM, Saelens BE, Gorin AA, Zenk SN, Berrigan D. Environmental data and methods from the Accumulating Data to optimally predict obesity treatment (ADOPT) core measures environmental working group. Data Brief. 2022;41:108002.
pubmed: 35300389 pmcid: 8920874 doi: 10.1016/j.dib.2022.108002
Diez Roux AV, Mair C. Neighborhoods and health. Ann N Y Acad Sci. 2010;1186:125–45.
pubmed: 20201871 doi: 10.1111/j.1749-6632.2009.05333.x
Shen J, Fuemmeler BF, Sheppard VB, Bear HD, Song R, Chow WH, Zhao H. Neighborhood disadvantage and biological aging biomarkers among breast cancer patients. Sci Rep. 2022;12(1):11006.
pubmed: 35773311 pmcid: 9246873 doi: 10.1038/s41598-022-15260-0
Lawrence KG, Kresovich JK, O’Brien KM, Hoang TT, Xu Z, Taylor JA, Sandler DP. Association of Neighborhood Deprivation with Epigenetic Aging using 4 Clock Metrics. JAMA Netw Open. 2020;3(11):e2024329.
pubmed: 33146735 pmcid: 7643028 doi: 10.1001/jamanetworkopen.2020.24329
Kind AJH, Buckingham WR. Making Neighborhood-Disadvantage Metrics Accessible - The Neighborhood Atlas. N Engl J Med. 2018;378(26):2456–8.
pubmed: 29949490 pmcid: 6051533 doi: 10.1056/NEJMp1802313
Diez Roux AV, Borrell LN, Haan M, Jackson SA, Schultz R. Neighbourhood environments and mortality in an elderly cohort: results from the cardiovascular health study. J Epidemiol Community Health. 2004;58(11):917–23.
pubmed: 15483307 doi: 10.1136/jech.2003.019596
Panczak R, Galobardes B, Voorpostel M, Spoerri A, Zwahlen M, Egger M, Swiss National C. Swiss Household P: a Swiss neighbourhood index of socioeconomic position: development and association with mortality. J Epidemiol Community Health. 2012;66(12):1129–36.
pubmed: 22717282 doi: 10.1136/jech-2011-200699
Li X, Sundquist J, Zoller B, Sundquist K. Neighborhood deprivation and lung cancer incidence and mortality: a multilevel analysis from Sweden. J Thorac Oncol. 2015;10(2):256–63.
pubmed: 25376515 doi: 10.1097/JTO.0000000000000417
Mancilla VJ, Peeri NC, Silzer T, Basha R, Felini M, Jones HP, Phillips N, Tao MH, Thyagarajan S, Vishwanatha JK. Understanding the Interplay between Health Disparities and Epigenomics. Front Genet. 2020;11:903.
pubmed: 32973872 pmcid: 7468461 doi: 10.3389/fgene.2020.00903
Alcaraz KI, Wiedt TL, Daniels EC, Yabroff KR, Guerra CE, Wender RC. Understanding and addressing social determinants to advance cancer health equity in the United States: a blueprint for practice, research, and policy. CA Cancer J Clin. 2020;70(1):31–46.
pubmed: 31661164 doi: 10.3322/caac.21586
Altice CK, Banegas MP, Tucker-Seeley RD, Yabroff KR. Financial hardships experienced by Cancer survivors: a systematic review. J Natl Cancer Inst 2017, 109(2).
Friedes C, Hazell SZ, Fu W, Hu C, Voong RK, Lee B, Feliciano JL, Nicholas LH, McNutt TR, Han P, et al. Longitudinal trends of Financial toxicity in patients with Lung Cancer: a prospective cohort study. JCO Oncol Pract. 2021;17(8):e1094–109.
pubmed: 33555936 doi: 10.1200/OP.20.00721
Lee A, Shah K, Chino F. Assessment of parking fees at National Cancer Institute-Designated Cancer Treatment Centers. JAMA Oncol. 2020;6(8):1295–7.
pubmed: 32672809 pmcid: 7366280 doi: 10.1001/jamaoncol.2020.1475
Chino F, Zafar SY. Financial Toxicity and Equitable Access to clinical trials. Am Soc Clin Oncol Educ Book. 2019;39:11–8.
pubmed: 31099681 doi: 10.1200/EDBK_100019
Richardson AS, Troxel WM, Ghosh-Dastidar M, Hunter GP, Beckman R, Colabianchi N, Collins RL, Dubowitz T. Pathways through which higher neighborhood crime is longitudinally associated with greater body mass index. Int J Behav Nutr Phys Act. 2017;14(1):155.
pubmed: 29121957 pmcid: 5679366 doi: 10.1186/s12966-017-0611-y
van Waart H, Stuiver MM, van Harten WH, Geleijn E, Kieffer JM, Buffart LM, de Maaker-Berkhof M, Boven E, Schrama J, Geenen MM, et al. Effect of low-intensity physical activity and moderate- to High-Intensity Physical Exercise during Adjuvant Chemotherapy on physical fitness, fatigue, and Chemotherapy Completion Rates: results of the PACES Randomized Clinical Trial. J Clin Oncol. 2015;33(17):1918–27.
pubmed: 25918291 doi: 10.1200/JCO.2014.59.1081
Bortolato B, Hyphantis TN, Valpione S, Perini G, Maes M, Morris G, Kubera M, Kohler CA, Fernandes BS, Stubbs B, et al. Depression in cancer: the many biobehavioral pathways driving tumor progression. Cancer Treat Rev. 2017;52:58–70.
pubmed: 27894012 doi: 10.1016/j.ctrv.2016.11.004
Obeng-Gyasi S, Graham N, Kumar S, Lee JW, Jacobus S, Weiss M, Cella D, Zhao F, Ip EH, O’Connell N, et al. Examining allostatic load, neighborhood socioeconomic status, symptom burden and mortality in multiple myeloma patients. Blood Cancer J. 2022;12(4):53.
pubmed: 35365604 pmcid: 8975964 doi: 10.1038/s41408-022-00648-y
Rojewski AM, Tanner NT, Dai L, Ravenel JG, Gebregziabher M, Silvestri GA, Toll BA. Tobacco Dependence predicts higher Lung Cancer and Mortality Rates and Lower Rates of Smoking Cessation in the National Lung Screening Trial. Chest. 2018;154(1):110–8.
pubmed: 29793736 pmcid: 6045783 doi: 10.1016/j.chest.2018.04.016
Edwards CV, Sheikh AR, Dennis MJ, Hunter A, Mackay ZP, Catudal EC, Elias R, Cabral HJ, Sarosiek SR, Tapan U. The impact of substance use on health care utilization, treatment, and outcomes in patients with non-small cell lung cancer. J Thorac Dis. 2022;14(10):3865–75.
pubmed: 36389291 pmcid: 9641327 doi: 10.21037/jtd-21-1992
Nawrot TS, Martens DS, Hara A, Plusquin M, Vangronsveld J, Roels HA, Staessen JA. Association of total cancer and lung cancer with environmental exposure to cadmium: the meta-analytical evidence. Cancer Causes Control. 2015;26(9):1281–8.
pubmed: 26109463 doi: 10.1007/s10552-015-0621-5
Li J, Li WX, Bai C, Song Y. Particulate matter-induced epigenetic changes and lung cancer. Clin Respir J. 2017;11(5):539–46.
pubmed: 26403658 doi: 10.1111/crj.12389
Hill W, Lim EL, Weeden CE, Lee C, Augustine M, Chen K, Kuan FC, Marongiu F, Evans EJ Jr., Moore DA, et al. Lung adenocarcinoma promotion by air pollutants. Nature. 2023;616(7955):159–67.
pubmed: 37020004 pmcid: 7614604 doi: 10.1038/s41586-023-05874-3
Lam LL, Emberly E, Fraser HB, Neumann SM, Chen E, Miller GE, Kobor MS. Factors underlying variable DNA methylation in a human community cohort. Proc Natl Acad Sci U S A. 2012;109(Suppl 2):17253–60.
pubmed: 23045638 pmcid: 3477380 doi: 10.1073/pnas.1121249109
Tehranifar P, Wu HC, Fan X, Flom JD, Ferris JS, Cho YH, Gonzalez K, Santella RM, Terry MB. Early life socioeconomic factors and genomic DNA methylation in mid-life. Epigenetics. 2013;8(1):23–7.
pubmed: 23196856 pmcid: 3549876 doi: 10.4161/epi.22989
Needham BL, Smith JA, Zhao W, Wang X, Mukherjee B, Kardia SL, Shively CA, Seeman TE, Liu Y, Diez Roux AV. Life course socioeconomic status and DNA methylation in genes related to stress reactivity and inflammation: the multi-ethnic study of atherosclerosis. Epigenetics. 2015;10(10):958–69.
pubmed: 26295359 pmcid: 4844216 doi: 10.1080/15592294.2015.1085139
Swartz JR, Hariri AR, Williamson DE. An epigenetic mechanism links socioeconomic status to changes in depression-related brain function in high-risk adolescents. Mol Psychiatry. 2017;22(2):209–14.
pubmed: 27217150 doi: 10.1038/mp.2016.82
McDade TW, Ryan C, Jones MJ, MacIsaac JL, Morin AM, Meyer JM, Borja JB, Miller GE, Kobor MS, Kuzawa CW. Social and physical environments early in development predict DNA methylation of inflammatory genes in young adulthood. Proc Natl Acad Sci U S A. 2017;114(29):7611–6.
pubmed: 28673994 pmcid: 5530653 doi: 10.1073/pnas.1620661114
Santos HP Jr., Bhattacharya A, Martin EM, Addo K, Psioda M, Smeester L, Joseph RM, Hooper SR, Frazier JA, Kuban KC, et al. Epigenome-wide DNA methylation in placentas from preterm infants: association with maternal socioeconomic status. Epigenetics. 2019;14(8):751–65.
pubmed: 31062658 pmcid: 6615526 doi: 10.1080/15592294.2019.1614743
Laubach ZM, Perng W, Cardenas A, Rifas-Shiman SL, Oken E, DeMeo D, Litonjua AA, Duca RC, Godderis L, Baccarelli A, et al. Socioeconomic status and DNA methylation from birth through mid-childhood: a prospective study in Project viva. Epigenomics. 2019;11(12):1413–27.
pubmed: 31509016 pmcid: 6802709 doi: 10.2217/epi-2019-0040
Yannatos I, Stites S, Brown RT, McMillan CT. Contributions of neighborhood social environment and air pollution exposure to Black-White disparities in epigenetic aging. PLoS ONE. 2023;18(7):e0287112.
pubmed: 37405974 pmcid: 10321643 doi: 10.1371/journal.pone.0287112
Baccarelli A, Tarantini L, Wright RO, Bollati V, Litonjua AA, Zanobetti A, Sparrow D, Vokonas PS, Schwartz J. Repetitive element DNA methylation and circulating endothelial and inflammation markers in the VA normative aging study. Epigenetics. 2010;5(3):222–8.
pubmed: 20305373 doi: 10.4161/epi.5.3.11377
Nwanaji-Enwerem JC, Colicino E, Trevisi L, Kloog I, Just AC, Shen J, Brennan K, Dereix A, Hou L, Vokonas P et al. Long-term ambient particle exposures and blood DNA methylation age: findings from the VA normative aging study. Environ Epigenet 2016, 2(2).
Huang SK, Tripathi P, Koneva LA, Cavalcante RG, Craig N, Scruggs AM, Sartor MA, Deng F, Chen Y. Effect of concentration and duration of particulate matter exposure on the transcriptome and DNA methylome of bronchial epithelial cells. Environ Epigenetics. 2021;7(1):dvaa022.
doi: 10.1093/eep/dvaa022
Wu H, Eckhardt CM, Baccarelli AA. Molecular mechanisms of environmental exposures and human disease. Nat Rev Genet. 2023;24(5):332–44.
pubmed: 36717624 pmcid: 10562207 doi: 10.1038/s41576-022-00569-3

Auteurs

Kathleen Kennedy (K)

Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA.

Ignacio Jusue-Torres (I)

Department of Neurologic Surgery, Mayo Clinic Health System, Eau Claire, WI, USA.

Ian D Buller (ID)

Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.

Emily Rossi (E)

Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.

Apurva Mallisetty (A)

Department of Surgery, Cancer Center, University of Illinois College of Medicine in Chicago, 909 South Wolcott Ave COMRB Suite 5140, Chicago, IL, 60612, USA.

Kristen Rodgers (K)

Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.

Beverly Lee (B)

Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.

Martha Menchaca (M)

Department of Radiology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA.

Mary Pasquinelli (M)

Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois College of Medicine in Chicago, Chicago, IL, USA.

Ryan H Nguyen (RH)

Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA.

Frank Weinberg (F)

Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA.

Israel Rubinstein (I)

Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois College of Medicine in Chicago, Chicago, IL, USA.
Division of Research Services, Jesse Brown VA Medical Center, Chicago, IL, USA.

James G Herman (JG)

Lung Cancer Program, University of Pittsburgh Cancer Institute, The Hillman Cancer Center, Pittsburgh, PA, USA.
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.

Malcolm Brock (M)

Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA.

Lawrence Feldman (L)

Department of Hematology Oncology, University of Illinois College of Medicine in Chicago, Chicago, IL, USA.
Division of Research Services, Jesse Brown VA Medical Center, Chicago, IL, USA.

Melinda C Aldrich (MC)

Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.

Alicia Hulbert (A)

Department of Surgery, Cancer Center, University of Illinois College of Medicine in Chicago, 909 South Wolcott Ave COMRB Suite 5140, Chicago, IL, 60612, USA. ahulbert@uic.edu.
Division of Research Services, Jesse Brown VA Medical Center, Chicago, IL, USA. ahulbert@uic.edu.
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA. ahulbert@uic.edu.

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