For HL most previous studies have shown a
For HL, most previous studies have shown a correlation between decreasing survival rates for patients with HL with decreasing SES, although several studies found no or a varied association between survival outcomes in patients with HL with decreasing SES. The differences in these findings may be attributable to different health care systems or area-based markers of SES. In our study, however, we demonstrated a similar result, suggesting that low SES predicted poor overall survival in the last decade. For NHL, rituximab played an important role in the field of treatment of CD20-positive B cell lymphoma in recent decades, and has profoundly altered the manner in which this disease is treated. Although low SES was correlated with poorer survival outcome after diagnosis of NHL in the pre-rituximab era despite universal health coverage among Canadian adults, the association remains unclear in the post-rituximab era. We demonstrated that a low combined SES score correlated with poor survival outcome, even in the post-rituximab era. There have been many Adriamycin HCl cost presented attempting to explain why lower SES predicted low survival outcome, including the state of advanced disease upon initial diagnosis, receipt of poorer cancer treatment, inadequate health insurance, lower complete response, increased fatal events during treatment, or inadequate long-term follow-up in patients. Personal factors may also contribute to reduced survival, similar to smoking related poorer health status and co-morbidity among cancer patients with various SES, nutritional status-related influence in treatment tolerance and survival sequentially, and male gender for more advanced disease at the time of diagnosis. In Taiwan, universal health coverage may have eliminated the impact of the medical factor, better equalizing treatment modalities among patients with different SES. However, the inequality of health status among these patients still existed. This suggests that personal factors play an important role in disease-related survival outcome. Although individual measures have been shown to be more strongly associated with health outcomes than neighborhood measures, neighborhood SES may influence health through the social, environmental, and physical environments of the neighborhood. Besides individual SES, neighborhood SES influenced mortality and other outcomes. Some studies controlling for both types of SES measures have found effects on health of neighborhood SES above and beyond those attributable to individual SES. Because disease outcome was contributed by many individual and neighborhood alteration factor, Kreb's cycle should make sense when both factors are taken into consideration. The impact of the cross-level interaction of individual SES and neighborhood SES was various in several malignancies. In our team, we had demonstrated the combined effect of individual and neighborhood SES in survival outcome in nasopharyngeal cancer, breast cancer, and lung cancer. Regarding our study, synchronous effect was documented such that high combined individual and neighborhood SES was correlated with better survival outcome in lymphoma, especially in non-Hodgkin type. There were some limitations to our study. First, there was potential for misclassification in the diagnosis of cancer and any co-morbid conditions which were completely dependent on ICD codes. Nonetheless, the National Health Insurance Bureau of Taiwan randomly reviews the charts and interviews patients in order to verify diagnostic accuracy. Second, the database does not contain information on potentially relevant clinical data such as performance status or biochemical laboratory examinations. Our study could not estimate the impact of these factors on survival. Third, detailed clinical information about grade, stage, and histological subtypes of lymphomas were not included in the dataset; however, previous studies have revealed no statistically significant associations between SES and tumor stage at the time of diagnosis in several malignancies, including Hodgkin lymphoma and follicular lymphoma and no significant association was found between SES and histological subgroups. Fourth, SES includes several factors, such as income, education, and occupation. Among them, income is frequently used as a surrogate for SES. In our study, since the information of education and occupation was not included in the database from NHIRD in Taiwan, we used income as the surrogate for SES.