Analysis of the relationship between social determinants of health and survival outcomes in gestational trophoblastic neoplasia in the United States.

Abstract

e17537 Background: Gestational trophoblastic neoplasia (GTN) is a rare disease with a reported incidence of 1 in 40,000 pregnancies. There have been no studies evaluating the impact of social determinants of health (SDH) on outcomes in GTN. This study seeks to examine the influence of social and biologic prognostic factors related to survival among women with GTN. We hypothesized that older age at diagnosis, lower household income, and marginalized, racial/ethnic groups are associated with worse prognosis. Methods: In this retrospective study, the Surveillance, Epidemiology, and End Results (SEER) database was used to identify women with GTN diagnosed from 2010-2018. Clinical-pathologic characteristics were described including initial stage of disease, presence of brain metastases at diagnosis, treatment with chemotherapy or surgery, and treatment at a Commission on Cancer (CoC) accredited center. Demographic factors were collected, including race/ethnicity, age at diagnosis, marital status, median household income, and rural or urban location. Log-logistic regression models were used to estimate the association between various prognostic factors and the odds of survival. We compared overall survival distributions across race/ethnicity using the log-rank test. Results: Of the 1,149 eligible patients (pts), 36% were non-Hispanic White (NHW), 21% non-Hispanic Black (NHB), 28% Hispanic, and 14% Other (Native American, Alaska Native, Asian, Pacific Islander). Mean age was 33.8 years (range 14-87 years). The majority was in the 21-35 age group (51%). Compared to NHW pts, Hispanic pts had over two times the odds of increased survival (OR 2.11; 95% CI 1.08-3.27; p = 0.032). NHB pts had similar survival compared to NHW pts (OR 1.06; 95% CI 0.50-1.76; p = 0.860). Poor prognostic factors demonstrating decreased odds of survival included age ≥40 years (OR 0.139; 95% CI 0.025-0.478; p < 0.001) and widowed status (OR 0.09; 95% CI 0.018-0.375; p < 0.001). Localized stage (OR 2.94; 95% CI 1.13-5.53; p = 0.03), the absence of brain metastases (OR 4.58; 95% CI 1.96-7.91; p = 0.002), and rural location (OR 5.62; 95% CI 1.25-15.2; p = 0.028) were significantly associated with increased odds of survival. Household income and race/ethnicity were not independent predictors of survival. Conclusions: Compared to NHW pts, Hispanic pts have an increased cause-specific survival for GTN. NHB pts and NHW pts have similar survival. Additionally, rural location was significantly associated with greater odds of survival. Further research is needed to investigate the underlying mechanisms linking race/ethnicity and survival outcomes, considering structural racism, bias, and discrimination. Our findings highlight the importance of recognizing the role of racism and SDH on health disparities and call to attention the need for addressing social inequities in GTN.