Annual household income and its association with financial toxicity, health utility, and survival in head and neck cancer.
Bibliographic record
Abstract
e18040 Background: While several studies have documented a link between socioeconomic status and survival in head and neck cancer, nearly all have used ecologic, community-based measures. Studies using more granular patient level data are lacking. We sought to determine the association between baseline annual household income with financial toxicity, health utility and survival. Methods: This was a prospective cohort of adult head and neck cancer patients treated at tertiary cancer center between September 17, 2015, and December 19, 2019. Our primary exposure was annual household income at time of diagnosis. Outcomes of interest included disease-free survival, financial toxicity, measured using the FIT tool, and health utility, measured using the Health Utilities Index Mark 3. Cox proportional hazards models were used to estimate the relationship between household income and survival. Income was regressed onto log-transformed FIT scores using linear models. The association between income and health utility was explored using generalized linear models. A generalized estimating equations approach was incorporated to account for patient level clustering. Results: There were 555 patients included in this cohort. Two-year disease-free survival was worse for patients in the bottom income quartile (< $30,000 - 67% [95%CI 58-78])) compared to the top quartile (≥$90,000 - 88% [95%CI 83-93]). In risk adjusted models, patients in the bottom income quartile had inferior disease-free survival (aHR 2.13 [95%CI 1.22-3.71]) but not overall survival (aHR 2.01 [95%CI 0.94-4.29]). The average FIT score was 22.6 in the lowest income quartile vs. 11.7 in the highest quartile. In adjusted analysis, low-income patients had 12-month FIT scores that were, on average, 134% higher (worse) [95%CI 16%-253%] than high-income patients. Similarly, health utility scores were, on average, 0.106 [95%CI 0.029-0.184] points lower for low-income patients. Conclusions: Head and neck cancer patients with a household income < $30,000 experienced worse financial toxicity, health status and disease-free survival. Significant disparities exist for Ontario’s head and neck cancer patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".