Short CommunicationGender differences on the interacting effects of marital status and health insurance on long-term colon cancer survival in California, 1995–2014
Section snippets
The cohort
Six thousand three hundred people diagnosed with colon cancer between 1995 and 2000 were randomly selected from the California cancer registry that was joined to the 2000 census by census tracts and followed until 2014. The original cohort oversampled the poor by stratifying as follows: a third each from high poverty neighbourhoods where 30% or more of the households were poor, 5%–29% were poor or where less than 5% were poor. This study then secondarily analysed the survival of 3021 women and
The complex interaction
The hypothesized five-way interaction was significant. Along with main effects, it could explain 42% of the variability in long-term colon cancer survival. All of the aggregate main effects alone could only explain 10% of such survival variability. Moreover, it suggested larger disadvantages among non-Medicare-eligible people, but there was not enough power to confidently describe all of the adjusted effects across the five-way interaction's numerous strata.
The significant four-way interaction,
Interpretation
Previous analyses of this California cohort of colon cancer patients focused on those who lived in poverty. We systematically replicated the fact that main effects alone, including race/ethnicity, explained well their long-term survival. The story seemed quite different, however, among the population of this study's central focus, those who did not live in profound poverty. Such diverse people are the near poor and members of the working class as well as members of the lower to upper middle
Acknowledgements
The authors gratefully acknowledge the administrative assistance of Kurt Snipes, Janet Bates and Gretchen Agha of the Cancer Surveillance and Research Branch, California Department of Public Health (CDPH) and Dee West and Marta Induni of the Cancer Registry of Greater California (CRGC). The authors also gratefully acknowledge the research, technical or editorial assistance of Glen Halvorson, Donald Fong and Arti Parikh-Patel of the CRGC and Madhan Balagurusamy, Nancy Richter, Daniel Edelstein
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