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 (HD*Calc). 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 = 15.8 (95% confidence interval [CI], 10.2-21.6); MLD = 16.2 (95% CI, 10.5-22.1)] and without [BGV = 19.3 (95% CI, 14.9-23.8); MLD = 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.

Figure 1.

Annual average Physical Composite Summary (PCS) (Panels a and b) and Mental Composite Summary (MCS) (Panels c and d) Scores in Medicare Advantage beneficiaries with and without a cancer history by race/ethnicity (1998–2012). Population norm line for the standard 1990 U.S. norm (bold black line) at a score of 50.