Trends in racial/ethnic disparity of health-related quality of life in older adults with and without cancer (1998-2012)

Abstract

Background: Non-White cancer survivors often report poorer health compared with Non-Hispanic Whites. Whether those disparities are changing over time is unknown. We examined changes in health-related quality of life (HRQOL) by race/ethnicity from 1998 to 2012 among older adults with and without cancer. Methods: Data from Medicare Advantage beneficiaries were obtained from the linkage between the Medicare Health Outcomes Survey and Surveillance, Epidemiology, and End Results cancer registry data (SEER-MHOS). HRQOL was assessed with the SF-36/ VR-12 Physical and Mental Component Scores (PCS/MCS) and 8 scales (Physical Functioning, Role-Physical, Bodily Pain, General Health, Vitality, Social Functioning, Mental Health, Role-Emotional). Annual average HRQOL scores, adjusting for age at survey, gender, number of comorbidities, education, and SEER registry, were compared over time. Absolute (between-group variance; BGV) and relative (mean log deviation; MLD) indices of disparity were generated using the National Cancer Institute's health disparities calculator (HDCalc). Joinpoint was used to test for significant changes in the slopes of the linear trend lines. Results: Racial/ethnic disparities in MCS increased in absolute and relative terms over time for those with [BGV ¼ 15.8 (95% confidence interval [CI], 10.2–21.6); MLD ¼ 16.2 (95% CI, 10.5–22.1)] and without [BGV ¼ 19.3 (95% CI, 14.9–23.8); MLD ¼ 19.6 (95% CI, 15.2–24.0)] cancer. PCS disparities over time did not significantly change. Changes in disparities in 5 of 8 HRQOL scales were significant in those with and without cancer. Conclusions: Older adults with cancer show increasing racial/ ethnic disparities in HRQOL, particularly in mental health status. Impact: Future research should evaluate trends in HRQOL and explore factors that contribute to health disparities.