The Impact of Economic Status on Cause-Specific Survival in Patients with Esophageal Adenocarcinoma in the United States: A Retrospective Analysis

Abstract

Objective This study aims to evaluate the impact of economic status on the cause-specific survival (CSS) of patients with esophageal adenocarcinoma (EAC). Methods Using propensity score matching (PSM), we analyzed data from 4676 patients with EAC, categorized into low household income (LHI) and high household income (HHI), sourced from the Surveillance, Epidemiology, and End Results database. Significant pre-PSM differences in age, gender, race, and tumor stage (T stage) were observed, necessitating PSM adjustment. The PSM incorporated these variables along with radiotherapy to balance the groups effectively. Kaplan–Meier curves and accelerated failure time (AFT) and random survival forest (RSF) models were used to assess the prognostic impacts. Results According to the pre-PSM data, a significant difference in CSS was observed between the LHI and HHI groups (median CSS = 1.25 years vs 1.50 years, P < .05). Post-PSM analysis maintained the result ( P < .05). Using the AFT model, HHI was found to significantly enhance CSS (pre-PSM time ratio [TR] = 1.145, post-PSM TR = 1.146). Male gender (pre-PSM TR = 0.762, post-PSM TR = 0.819) and certain non-single marital statuses (such as divorced, pre- and post-TRs <1.000) are also prognostic risk factors for EAC ( P values <.05). Additional significant prognostic risk factors for EAC included advanced American Joint Committee on Cancer stages (III and IV), higher tumor stages (T3 and T4), higher node stages (N1–N3), without surgery, and without chemotherapy, as identified using the AFT and/or RSF mothods. The results derived from the RSF model are consistent with those of the AFT model. Conclusion Higher economic status is positively related to EAC CSS. Beyond standard clinical treatments, interventions such as enhancing socioeconomic support and preventive aspects, including intensive health education and EAC screening, could play a crucial role in improving EAC prognosis.