Area Deprivation Index Quartile Research Articles

Social Vulnerability Index Provides Greater Granularity Compared to the Area Deprivation Index When Assessing Outcomes Following Elective Lumbar Fusion.

Retrospective review of a single institution cohort. To determine whether Area Deprivation Index (ADI) or Social Vulnerability Index (SVI) is more suitable for evaluating minimum clinically important difference (MCID) achievement following elective lumbar fusion as captured by the Patient Reported Outcomes Measurement Information System (PROMIS). A total of 182 patients who underwent elective one- to two-level posterior lumbar fusion between January 2015 and September 2021. ADI and SVI values were calculated from patient-supplied addresses. Patients were grouped into quartiles based on values; higher quartiles represented greater disadvantage. MCID thresholds for Pain Interference (PI) and Physical Function (PF) were determined via a distribution-based method. Multivariable logistic regression was performed to identify factors impacting MCID attainment. Univariate logistic regression was performed to determine which themes comprising SVI values affected MCID achievement. Statistical significance was set at P<0.05. Multivariate logistic regression demonstrated that ADI and SVI quartile assignment significantly impacted achievement of MCID for PI (P=0.04 and P=0.01 respectively) and PF (P=0.03 and P=0.02 respectively). Specifically, assignment to the third ADI and SVI quartiles were significant for PI (OR: 0.39 and 0.23 respectively), and PF (OR: 0.24 and 0.22 respectively). Race was not a significant predictor of MCID for either PI or PF. Univariate logistic regression demonstrated that among SVI themes, the socioeconomic status theme significantly affected achievement of MCID for PI (P=0.01), while the housing type and transportation theme significantly affected achievement of MCID for PF (P=0.01). ADI and SVI quartile assignment were predictors of MCID achievement. While ADI and SVI may both identify patients at risk for adverse outcomes following lumbar fusion, SVI offers greater granularity in terms of isolating themes of disadvantage impacting MCID achievement.

Neighborhood-Level Disadvantage and Delayed Adjuvant Therapy in Head and Neck Cancer

For patients with head and neck squamous cell carcinoma (HNSCC), initiation of postoperative radiation therapy (PORT) within 6 weeks of surgery is recommended by the National Comprehensive Cancer Network Guidelines and the Commission on Cancer. Although individual-level measures of socioeconomic status are associated with receipt of timely, guideline-adherent PORT, the role of neighborhood-level disadvantage has not been examined. To characterize the association of neighborhood-level disadvantage with delays in receiving PORT. This retrospective cohort study included 681 adult patients with HNSCC undergoing curative-intent surgery and PORT from 2018 to 2020 at 4 US academic medical centers. The data were analyzed between June 21, 2023, and March 5, 2024. The primary outcome was delay in initiating guideline-adherent PORT (ie, >6 weeks after surgery). Time-to-PORT (TTP) was a secondary outcome. Census block-level Area Deprivation Index (ADI) scores were calculated and reported as national percentiles (0-100); higher scores indicate greater deprivation. The association of ADI scores with PORT delay was assessed using multivariable logistic regression adjusted for demographic, clinical, and institutional characteristics. PORT initiation across ADI score population quartiles was evaluated with cumulative incidence plots and Cox models. Among 681 patients with HNSCC undergoing surgery and PORT (mean [SD] age, 61.5 [11.2] years; 487 [71.5%] men, 194 [29.5%] women) the PORT delay rate was 60.8% (414/681) and median (IQR) TTP was 46 (40-56) days. The median (IQR) ADI score was 62.0 (44.0-83.0). Each 25-point increase in ADI score was associated with a corresponding 32% increase in the adjusted odds ratio (aOR) of PORT delay (aOR, 1.32; 95% CI, 1.07-1.63) on multivariable regression adjusted for institution, age, race and ethnicity, insurance, comorbidity, cancer subsite, stage, postoperative complications, care fragmentation, travel distance, and rurality. Increasing ADI score population quartiles were associated with increasing TTP (hazard ratio of PORT initiation, 0.71; 95% CI, 0.53-0.96; 0.59; 95% CI, 0.44-0.77; and 0.54; 95% CI, 0.41-0.72; for ADI quartiles 2, 3, and 4 vs ADI quartile 1, respectively). Increasing neighborhood-level disadvantage was independently associated with a greater likelihood of PORT delay and longer TTP in a dose-dependent manner. These findings indicate a critical need for the development of multilevel strategies to improve the equitable delivery of timely, guideline-adherent PORT.

Abstract 4838: Impact of social determinants of health (SDH) on systemic therapy and survival in young women with breast cancer

Abstract Introduction: Health disparities are often influenced by SDH. Breast cancer patients (pts) with negative SDH may experience less access to treatment, which can impact outcomes. This study evaluated the association between SDH, utilization of medical therapy, and outcomes in young pts with early breast cancer. Methods: We performed a retrospective review of female pts 18-40 years old in the Young Women’s Breast Cancer Database at a single institution with non-metastatic breast cancer diagnosed from 2011-2020. Predefined SDH were recorded along with clinical characteristics at diagnosis. Descriptive statistics and logistic regression analyses were performed. Survival analyses were conducted using Kaplan-Meier and Cox Proportional Hazard model. Results: 1,061 pts were eligible for analysis; 67% were White, 27% Black, 4% Asian, and 3% Other. Additional demographic and clinical characteristics are shown in Table 1. Pts with Medicaid received chemotherapy (chemo) more often than pts with private insurance (OR 2.04, p=0.003), as did self-pay/uninsured pts (OR 1.74, p=0.003). Divorced/separated/widowed pts were more likely to receive chemo than married pts (OR 1.85, p=0.049). Pts living in 1st quartile of area deprivation index (ADI) received chemo less than those in the 4th ADI quartile (OR 0.45, p=0.003). Divorced/separated/widowed pts with HR+ disease were less likely to receive endocrine treatment than married pts (OR 0.48, p=0.039). Worse overall survival (OS) was seen for Black vs White pts (HR 1.72, p&amp;lt;.001); pts with Medicaid or self-pay/uninsured vs privately insured (HR 1.67, HR 1.92; p=0.025); and unemployed vs employed pts (HR 2.49, p&amp;lt;.001) adjusted for chemo use and clinical stage. Conclusions: Young pts experiencing negative SDH were more likely to receive chemo, less likely to take endocrine therapy if indicated, and suffered from worse OS. These findings may highlight the influence of a pt’s social network on access to care and treatment completion. Table 1. Demographics &amp; clinical characteristics in young women with early-stage breast cancer Demographic Characteristics Overall, N=1061 Race Asian: 40 (3.9 %) Black or African American: 270 (26.6 %) Other: 29 (2.9 %) White or Caucasian: 677 (66.6 %) Ethnicity Hispanic or Latino: 86 (8.4 %) Non-Hispanic or Non-Latino: 939 (91.6%) Insurance Type Private: 824 (77.7 %) Medicare: 16 (1.5 %) Medicaid: 145 (13.7 %) Self-pay/Uninsured: 75 (7.1 %) Area Deprivation Index (ADI) Quartile* Q1= 1-25: 215 (20.3 %) Q2= 26-50: 375 (35.4 %) Q3= 51-75: 315 (29.7 %) Q4= 76-100: 155 (14.6 %) Median Household Income &amp;lt;45000: 44 (4.1 %) 45000-79,999: 600 (56.6 %) 80000-119,999: 304 (28.7 %) ≥120,000: 112 (10.6 %) Employment status Unemployed: 224 (21.1 %) Employed: 657 (61.9 %) Unknown: 180 (17.0 %) Marital Status Married: 631 (59.8 %) Single: 355 (33.6 %) Separated/Divorced/Widowed: 70 (6.6 %) Clinical Characteristics Clinical AJCC Stage Stage 0: 149 (14.3 %) Stage I: 335 (32.1 %) Stage II: 430 (41.2 %) Stage III: 129 (12.4 %) Receptor Status HR+/HER2+: 174 (19.9 %) HR+/HER2-: 519 (59.3 %) HR-/HER2-: 182 (20.8 %) Utilization of Chemotherapy Yes: 702 (67.1 %) No: 344 (32.9 %) Utilization of Endocrine Therapy Yes: 451 (43.3 %) No: 590 (56.7 %) Recurrence Status Yes: 111 (10.5 %) No: 942 (89.5 %) Survival Status Alive: 868 (81.8 %) Dead: 101 (9.5 %) Lost to follow-up: 92 (8.7 %) *Higher score correlates with greater disadvantage Citation Format: Natalie J. Reed, Ferdous Ahmed, Courtney Schepel, Lejla Hadzikadic-Gusic, Julie Fisher, Antoinette R. Tan, Arielle L. Heeke. Impact of social determinants of health (SDH) on systemic therapy and survival in young women with breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4838.

Most deprived Louisiana census tracts have higher hepatocellular carcinoma incidence and worse survival.

Liver cancer incidence increased in the US from 1975 through 2015 with heterogeneous rates across subpopulations. Upstream or distal area-level factors impact liver cancer risks. The aim of this study was to examine the association between area-level deprivation and hepatocellular carcinoma (HCC) incidence and survival. We also explored the association between area deprivation and treatment modalities. Louisiana Tumor Registry identified 4,151 adult patients diagnosed with malignant HCC from 2011 to 2020 and linked residential address to census tract (CT)-level Area Deprivation Index (ADI) categorized into quartiles (Q1 = least deprived). ANOVA examined the association between ADI quartile and CT age-adjusted incidence rate (AAIR) per 100,000. Chi-square tested the distribution of demographic and clinical characteristics across ADI quartiles. Kaplan-Meier and proportional hazard models evaluated survival by deprivation quartile. Among the 1,084 CTs with incident HCC, the average (SD) AAIR was 8.02 (7.05) HCC cases per 100,000 population. ADI was observed to be associated with incidence, and the mean (SD) AAIR increased from 5.80 (4.75) in Q1 to 9.26 (7.88) in Q4. ADI was also associated with receipt of surgery (p < 0.01) and radiation (p < 0.01) but not chemotherapy (p = 0.15). However, among those who received chemotherapy, people living in the least deprived areas began treatment approximately 10 days sooner than those living in other quartiles. Q4 patients experienced the worst survival with a median of 247 (95% CI 211-290) days vs. Q1 patients with a median of 474 (95% CI 407-547) days (p < 0.0001). Q4 had marginally poorer survival (HR 1.20, 1.05-1.37) than Q1 but the association became non-significant (HR 1.12, 0.96-1.30) when adjusted for rurality, liquor store density, sex, race/ethnicity, age, insurance, BMI, stage, hepatitis diagnosis, and comorbidities. Increasing neighborhood (CT) deprivation (ADI) was observed to be associated with increased HCC incidence and poorer HCC survival. However, the association with poorer survival becomes attenuated after adjusting for putative confounders.

Socioeconomic disparities based on shooting intent in pediatric firearm injury.

Pediatric firearm injury is often associated with socioeconomically disadvantaged neighborhoods. Most studies only include fatal injuries and do not differentiate by shooting intent. We hypothesized that differences in neighborhood socioeconomic disadvantage would be observed among shooting intents of fatal and nonfatal cases. A linked integrated database of pediatric fatal and nonfatal firearm injuries was developed from trauma center and medical examiner records in Harris County, Texas (2018-2020). Geospatial analysis was utilized to map victim residence locations, stratified by shooting intent. Area Deprivation Index (ADI), a composite measure of neighborhood socioeconomic disadvantage at the census tract level was linked to shooting intent. Differences in high ADI (more deprived) versus low ADI among the shooting intents were assessed. Unadjusted and adjusted regression models assessed differences in ADI scores across shooting intent, adjusted models controlled for age, gender, and race/ethnicity. Of 324 pediatric firearm injuries, 28% were fatal; 77% were classified as interpersonal violence, 15% unintentional, and 8% self-harm. Differences were noted among shooting intent across the ADI quartiles; with increases in ADI score, the odds of interpersonal violence injuries compared to self-harm injuries significantly increased by 5%; however, when adjusting for individual-level variables of age, gender, and race and ethnicity, no significant differences in ADI were noted. Our results suggest that children living in disadvantaged neighborhoods are more likely to be affected by interpersonal firearm violence compared to self-harm; however, when differences in race/ethnicity are considered, the differences attributable to neighborhood-level disadvantage disappeared. Resources should be dedicated to improving structural aspects of neighborhood disadvantage, which disproportionately impact racial/ethnic minoritized populations. Furthermore, firearm self-harm injuries occurred among children living in the less disadvantaged neighborhoods. Understanding the associations among individual and neighborhood-level factors are important for developing streamlined injury prevention interventions by shooting intent. Level IVStudy TypePrognostic/Epidemiological.

Abstract A137: Drive time to physicians and outcomes for bladder cancer

Abstract Introduction: Poor geographic access to cancer care providers can delay treatment and limit access to high quality care. Previous research has shown that for patients with bladder cancer, time to cystectomy and receipt of neoadjuvant chemotherapy are associated with improved survival. Travel burden may be an important barrier to timely guideline-concordant treatment and is particularly relevant for residents of rural areas, which are often medically underserved. This study examines the association between drive time to medical oncologists and urologists and clinical outcomes for muscle-invasive bladder cancer (MIBC) patients. Data and Methods: We used information on physician location from the Centers for Medicare and Medicaid Services and patient-level data from the 2010-2016 Pennsylvania Cancer Registry linked to Pennsylvania Healthcare Cost Containment Council (PHC4) inpatient discharge data through 2018. We examined patients in Pennsylvania with a first lifetime bladder cancer diagnosis who underwent radical cystectomy at a non-federal short-term general hospital identified in PHC4. Outcomes examined were surgery within 90 days, receipt of neoadjuvant chemotherapy, 90-day mortality and 90-day readmission. We estimated multivariable linear regression models at the patient level. Our primary exposures were the natural log number of minutes from the patient’s home census tract centroid to the nearest medical oncologist and the nearest urologist. We controlled for patient age, sex, race/ethnicity, tumor size, tumor node involvement, and Elixhauser comorbidity index. We included a control for whether the patient received neoadjuvant chemotherapy in models estimating the association between drive times and cystectomy within 90 days. We also controlled for area-level characteristics, including ZIP code median and area deprivation index quartile. Standard errors were clustered at the county level.Results: The study included 954 patients with MIBC, 1,520 medical oncologists, and 976 urologists in Pennsylvania. Mean (SD) drive time to the nearest oncologist was 17.1 (11.4) minutes and median drive time was 14.4 minutes. Mean drive time to the nearest urologist was 13.9 (9.2) minutes and median drive time was 11.7 minutes. A 30-minute increase in drive time to the nearest urologist was associated with a 12.5 percentage point lower likelihood of undergoing cystectomy within 90 days (95% CI: -24.3 to -0.6). A 30-minute increase in drive time to the nearest oncologist was associated with an 11.9 percentage point lower likelihood of receiving neoadjuvant chemotherapy (95% CI: -23.4 to -0.4). Drive time was not significantly associated with 90-day mortality or readmission within 90 days. Conclusions: Drive time to both oncologists and urologists is associated with timely receipt of guideline-recommended care for patients with MIBC. Understanding the impact of geographic access to medical oncologists and urologists on clinical outcomes for patients with MIBC can inform providers and policymakers in addressing geographic equity in cancer care. Citation Format: Sruthi Muluk, Coleman Drake, Zhaojun Sun, Manisha Bhattacharya, Bruce Jacobs, Lindsay M. Sabik. Drive time to physicians and outcomes for bladder cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A137.

Does Socioeconomic Status Have an Impact on Light Chain (AL) Amyloidosis Disease Characteristics and Outcomes?

Background: Evidence suggests that low socioeconomic status leads to unequal access to care and outcomes. This can be particularly problematic for rarer diseases such as light chain (AL) amyloidosis. Using the Area Deprivation Index (ADI) as a proxy for socioeconomic status (SES), we hypothesized that persons living in areas with greater deprivation will exhibit differences in AL disease characteristics at diagnosis and worse post-diagnosis outcomes. Methods: We conducted an IRB-approved, retrospective chart review of patients with systemic AL amyloidosis seen between January 1, 2010 and December 31, 2022 at a large and diverse health system in Milwaukee, Wisconsin. Patients with localized amyloidosis were excluded. Patients were identified using electronic health records. Demographic information (age, sex, race, zip code of residence, insurance, and marital status), disease characteristics (amyloid stage at diagnosis, type, and number of organs involved), and treatment indicators (stem cell transplant eligibility and utilization, time to first chemotherapy) were extracted for all eligible patients. The 2020 Area Deprivation Index (0-100, higher scores equating to higher deprivation) was calculated through the Neighborhood Atlas ® database using zip code and analyzed in quartiles. Spearman correlation was used to describe differences in sociodemographic and clinical characteristics across ADI quartiles and a Cox regression analysis was conducted for overall survival testing the association of ADI controlling for age, sex, race, disease stage, and number of involved organs. A p-value of &amp;lt;0.05 was considered statistically significant. Results: Of the 200 patients with systemic AL amyloidosis who met our inclusion criteria, 8 patients were excluded due to missing/other race. Of the remaining 192 patients which comprised our final cohort, 171 (89%) were White, 21 (11%) were Black. Over half of all patients (51.5%) lived in neighborhoods in the two highest ADI quartiles. Patients in different ADI quartile categories differed significantly by race (Black and White, p&amp;lt;0.001), age at diagnosis (p=0.012), marital status (p&amp;lt;0.001), and Medicaid insurance (p&amp;lt;0.001) (Table 1). Differences in diagnostic and treatment characteristics were not observed across ADI quartiles (Table 1). There were also no differences in overall survival at 1, 5, and 8 years across ADI quartiles (p=0.48). Multivariable analyses revealed that older age at diagnosis, but not ADI, were associated with worse survival (Table 2). Interestingly, while stage 4 diagnosis alone was significant for worse survival (p=&amp;lt;0.001), in general there was no significant correlation between staging and survival (overall p-value=0.497) (Table 2). Controlling for ADI and other factors, Black AL patients were twice as likely as White AL patients to die (OR=2.10; 95% CI: 0.98-4.51), with a p-value of 0.058, marginally short of statistical significance. Conclusion: Socioeconomic status, as measured by the Area Deprivation Index of the neighborhood of residence, was not associated with disease characteristics, treatment, and outcomes among patients with AL amyloidosis. Controlling for SES, however, Black AL patients had worse survival outcomes then their White counterparts. While there was no significant correlation between ADI and clinical characteristics, a substantial proportion of the cohort was living in highly socioeconomically disadvantaged neighborhoods. Given the nature of our study, we were only able to analyze patients who were seen at our institution and our sample size was small. Studies of larger, multicenter populations are needed to better assess the effects of socioeconomic status and other social determinants of health on outcomes among patients with AL amyloidosis.

Neighborhood Disadvantage Is Associated with Inferior Overall Survival for Acute Myeloid Leukemia Patients Treated with Standard Intensive Induction

Background: Identifying biologic and socioeconomic contributors to disparities in outcomes is critical for the management of acute myeloid leukemia (AML). Prior studies in AML revealed that Black patients (pts) have inferior survival compared to White pts, with more striking disparity for Black pts aged &amp;lt;60. We previously explored our large and diverse AML cohort from urban and large rural areas and did not identify inferior survival for pts with self-reported Black race or Hispanic ethnicity. Although no surrogates for social determinants of health (SDOH) or insurance status were recognized as contributing to survival differences, oncology nurse navigation (ONN) was associated with a survival benefit, with no significant difference in access to ONN among racial or ethnic groups. To further evaluate socioeconomic drivers of disparities in this population supported by ONN, we aim to use the Area Deprivation Index (ADI) to determine the impact of neighborhood disadvantage on survival in AML. Methods: AMLpts diagnosed at Levine Cancer Institute between 12/2015 and 12/2020 were included. Pts with acute promyelocytic leukemia (APL) were excluded from this analysis. Details regarding insurance coverage, ONN services, induction therapy, stem cell transplant (SCT) status, and survival outcomes were collected. Race and ethnicity were self-reported. European LeukemiaNet (ELN) 2017 criteria were used to assign AML risk. Pt and disease characteristics were summarized, described, and compared with Fisher exact tests and Wilcoxon rank-sum tests for categorical and continuous data, respectively. Pts were grouped into 4 quartiles based on ADI national percentile. Subsequent models were fit with ADI dichotomized at the median after adjacent ADI groups were removed with backward elimination. Associations between overall survival (OS) and pt and disease characteristics, insurance status, race, ethnicity, ONN services, and ADI were investigated. OS was defined as the time from diagnosis (dx) to death from any cause, with surviving subjects censored at the time of last follow-up. Kaplan-Meier methods were used to summarize OS and calculate landmark survival rates. Survival was compared with unadjusted log-rank tests. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CIs) associated with OS. Results: Three hundred eighty pts with available baseline characteristics were included in our analysis ( Table 1) . For pts &amp;lt;60 who received intensive induction and had available ADI (N=86), there was a significant difference in OS amongst the quartiles of ADI (P=0.007), with differences even more pronounced with dichotomized ADI (P&amp;lt;0.001) ( Figure 1). With a median follow-up of 38.1 months for the intensively treated pts &amp;lt;60, the estimated two-year OS was 96.6% for more advantaged/low ADI pts and 55.4% for less advantaged/high ADI pts (HR 5.21; 95% CI 1.82 to 14.95). Within the cohort of pts &amp;lt;60 who received intensive induction, sixty-eight percent were Non-Hispanic White and 28% were Non-Hispanic Black. Many (66%) were privately insured at dx, with 24% uninsured or with Medicaid. ONN services were accessed by most (72%) pts with known ADI. Care barriers were expressed by pts of all ADI quartiles, with transportation being the only barrier most reported by pts of increased disadvantage (P&amp;lt;0.01). Forty-two percent of pts received SCT (N=38). Nearly 60% of socially advantaged pts (ADI≤51) received SCT versus 33% of socially disadvantaged pts (P=0.03). In univariate models, receipt of SCT (P=0.016) was associated with improved OS while receiving navigation services (P=0.32) was not. Conclusions: Higher ADI was associated with inferior OS in AML pts &amp;lt;60 who received intensive induction. Receipt of SCT was observed more often in pts with more neighborhood advantage, which is of great importance since SCT improved OS in this cohort. Although insurance status is often linked to SCT access, insurance status did not significantly impact OS. Of the ONN reported barriers to care, transportation issues had a greater impact on pts with more neighborhood disadvantage. Expanding access to SCT and addressing barriers to care, such as transportation, is necessary to overcome the detrimental impact of neighborhood disadvantage on survival in AML.

The Impact of Social Determinants of Health on Outcomes and Complications After Total Knee Arthroplasty: An Analysis of Neighborhood Deprivation Indices.

Social determinants of health (SDOH) are important factors in the delivery of orthopaedic care. The purpose of this study was to investigate the relationship between outcomes following total knee arthroplasty (TKA) and both the Social Vulnerability Index (SVI) and the Area Deprivation Index (ADI). The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database was utilized to identify TKA cases for inclusion. Demographic characteristics and medical history were documented. The SVI, its subthemes, and the ADI were analyzed. Outcome data included length of stay, discharge disposition, postoperative change in the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS, JR), 90-day incidences of emergency department (ED) visits, readmission, death, deep venous thrombosis (DVT) and/or pulmonary embolism (PE), periprosthetic fracture, implant failure, periprosthetic joint infection (PJI), and all-cause reoperation. Database cross-referencing was completed to document aseptic and septic revisions beyond 90 days postoperatively. Bivariate quartile-stratified and multivariable analyses were used to associate deprivation metrics with outcomes. A total of 19,321 TKA cases met inclusion criteria. Baseline patient characteristics varied among the SVI and/or ADI quartiles, with patients of non-White race and with a greater number of comorbidities noted in higher deprivation quartiles. Higher SVI and/or ADI quartiles were correlated with an increased rate of discharge to a skilled nursing facility (p < 0.05). A higher SVI and/or ADI quartile was associated with increased incidences of ED visits and readmissions postoperatively (p < 0.05). DVT and/or PE and long-term aseptic revision were the complications most strongly associated with higher deprivation metrics. Upon multivariable analysis, greater length of stay and greater incidences of ED visits, readmissions, DVT and/or PE, and aseptic revision remained significantly associated with greater deprivation based on multiple metrics. Greater deprivation based on multiple SVI subthemes, the composite SVI, and the ADI was significantly associated with increased length of stay, non-home discharge ED visits, and readmissions. The SVI and the ADI may be important considerations in the perioperative assessment of patients who undergo TKA. Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.

Socioeconomic Disadvantage Is Associated with Decreased Long-Term Survival in Adolescent and Young Adult Patients with Acute Lymphoblastic Leukemia

Background: The treatment of acute lymphoblastic leukemia (ALL) in the adolescent and young adult (AYA) population has dramatically improved over the past decade with the use of pediatric-inspired regimens increasing long-term survival rates to over 60%. Despite these advances, AYA patients with ALL have seen persistent disparities in survival by race and ethnic background. The primary objective of this study is to examine socioeconomic disadvantage as a driver of the racial and ethnic disparities that exist among AYAs with ALL using a nationally representative cancer registry. Methods: The cohort was identified using the SEER*Stat software, which utilizes Surveillance, Epidemiology, and End Results (SEER) data from the National Cancer Institute (NCI). All SEER patients diagnosed at age 15 to 39 years with ALL from January 1, 2005 to December 31, 2019 were included in the analysis. Patients were excluded from analysis if they had an unknown cause of death, were diagnosed with ALL only postmortem, had no survival time listed, or did not have a recorded age. We utilized the area deprivation index (ADI) as a measure of socioeconomic disadvantage, and patients were excluded if they were in a county that did not have a corresponding ADI score (0.3%). ADI scores were calculated by county using the ‘Sociome’ package in R software. Both the 2009 and 2019 county ADI scores were used based on patient diagnosis year. ADI quartiles were then assigned by decade (2000-2009 and 2010-2019). The quartiles were calculated by first identifying the median ADI score for each decade, and then assessing the median of the lower and upper half to determine the lower and upper quartile value. Analyses were also completed by state Medicaid expansion status. Both cause-specific and observed survival (OS) were calculated by five-year periods from 2005 to 2019. The net survival time was assessed at 12 to 60 months in 12-month increments for 2005-2014 with only an upper limit of 48 months survival able to be calculated for patients diagnosed between 2015-2019. The Kaplan-Meier Method was used for all survival calculations. Results: A total of 4,382 patients were found to meet criteria for inclusion. Specific characteristics of the analyzed population are listed in Table 1. OS for the entire group was 60.6% at 60 months (95% CI 58.9%-62.3%), with a cause-specific survival at 60 months of 64.3% (95% CI 62.7%-65.9%). For AYA ALL patients diagnosed from 2005 to 2009, cause-specific survival for the ADI quartiles diverged over time and at 48 months was significantly higher in patients residing in a county with an ADI value of 1 (least disadvantaged) than in those residing in a county with an ADI value of 4 (most disadvantaged) [66.6%, 95% CI 62.5-70.4% versus 51.2%, 95% CI 40.2-61.2% p&amp;lt;0.05], although this difference was not significant at 60 months. This difference was also seen in OS at 48 months and persisted at 60 months [62.0%, 95% CI 57.9-65.8% versus 45.7%, 95% CI 35.3-55.5% (48 mo.) and 59.7%, 95% CI 55.6-63.5% versus 45.7%, 95% CI 35.3-55.5% (60 mo.) p&amp;lt;0.05]. There was no significant difference in cause-specific or OS by ADI quartile for patients diagnosed from 2010-2014. However, this difference in survival reoccurred in the most recent data available (Figure 1). For AYA ALL patients diagnosed from 2015 to 2019, cause-specific survival at 36 and 48 months was significantly higher in patients residing in a county with an ADI value of 1 than in those residing in a county with an ADI value of 4 [79.7%, 95% CI 75.6-83.2% versus 65.8%, 95% CI 55.8-74.0% (36 mo.) and 78.6%, 95% CI 74.2-82.3% versus 62.4%, 95% CI 51.8-71.3% (48 mo.) all p&amp;lt;0.05]. This difference was also seen in OS for all survival intervals from 12 to 48 months [90.2%, 95% CI 87.6-92.3% versus 81.3%, 95% CI 74.4-86.5% (12 mo.); 82.9%, 95% CI 79.4-85.8% versus 72.9%, 95% CI 64.9-79.3% (24 mo.); 77.1%, 95% CI 72.9-80.7% versus 62.1%, 95% CI 52.4-70.3% (36 mo.); and 76.0%, 95% CI 71.6-79.8% versus 58.8%, 95% CI 48.6-67.7% (48 mo.) all p&amp;lt;0.05]. There were no statistically significant differences noted in cause-specific and observed survival between states that expanded Medicaid versus those that did not. Conclusions: Socioeconomic disadvantage was associated with significantly worse long-term survival in AYA patients with ALL. This gap reappears over time despite both treatment innovations and public policy changes. Urgent interventional approaches are needed to target this highly vulnerable population.

Neighborhood Socioeconomic Disadvantage and Abnormal Birth Weight.

To examine whether exposure to community or neighborhood socioeconomic disadvantage as measured by the ADI (Area Deprivation Index) is associated with risk of abnormal birth weight among nulliparous individuals with singleton gestations. This was a secondary analysis from the prospective cohort NuMoM2b study (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be). Participant addresses at cohort enrollment between 6 and 13 weeks of gestation were geocoded at the Census tract level and linked to the 2015 ADI. The ADI, which incorporates the domains of income, education, employment, and housing quality into a composite national ranking of neighborhood socioeconomic disadvantage, was categorized by quartiles (quartile 1, least disadvantaged, reference; quartile 4, most disadvantaged). Outcomes were large for gestational age (LGA; birth weight at or above the 90th percentile) and small for gestational age (SGA; birth weight below the 10th percentile) compared with appropriate for gestational age (AGA; birth weight 10th-90th percentile) as determined with the 2017 U.S. natality reference data, standardized for fetal sex. Multinomial logistic regression models were adjusted for potential confounding variables. Of 8,983 assessed deliveries in the analytic population, 12.7% (n=1,143) were SGA, 8.2% (n=738) were LGA, and 79.1% (n=7,102) were AGA. Pregnant individuals living in the highest ADI quartile (quartile 4, 17.8%) had an increased odds of delivering an SGA neonate compared with those in the lowest referent quartile (quartile 1, 12.4%) (adjusted odds ratio [aOR] 1.32, 95% CI 1.09-1.55). Pregnant individuals living in higher ADI quartiles (quartile 2, 10.3%; quartile 3, 10.7%; quartile 4, 9.2%) had an increased odds of delivering an LGA neonate compared with those in the lowest referent quartile (quartile 1, 8.2%) (aOR: quartile 2, 1.40, 95% CI 1.19-1.61; quartile 3, 1.35, 95% CI 1.09-1.61; quartile 4, 1.47, 95% CI 1.20-1.74). Neonates of nulliparous pregnant individuals living in U.S. neighborhoods with higher area deprivation were more likely to have abnormal birth weights at both extremes.

Evaluating potential disparities in geospatial access to American College of Surgeons/American Association for the Surgery of Trauma-verified emergency general surgery centers.

The American Association for the Surgery of Trauma and the American College of Surgeons have recently introduced emergency general surgery (EGS) center verification, which could enhance patient outcomes. Distance and resource availability may affect access to these centers, which has been linked to higher mortality. Although many patients can receive adequate care at community centers, those with critical conditions may require specialized treatment at EGS-verified centers. We aimed to evaluate geospatial access to potential EGS-verified centers and identify disparities across different scenarios of EGS verification program uptake in the United States. We used hospital capabilities and verified pilot centers to estimate potential patterns of which centers would become EGS verified under four scenarios (EGS centers, high-volume EGS centers, high-volume EGS plus level 1 trauma centers, and quaternary referral centers). We calculated the spatial accessibility index using an enhanced two-step floating catchment technique to determine geospatial access for each scenario. We also evaluated social determinants of health across geospatial access using the Area Deprivation Index (ADI). A total of 1,932 hospitals were categorized as EGS centers, 307 as high-volume EGS centers, 401 as high-volume EGS plus level 1trauma centers, and 146 as quaternary centers. Spatial accessibility index decreased as the stringency of EGS verification increased in each scenario (226.6 [111.7-330.7], 51.8 [0-126.1], 71.52 [3.34-164.56], 6.2 [0-62.2]; p < 0.001). Within each scenario, spatial accessibility index also declined as the ADI quartile increased ( p < 0.001). The high-volume EGS plus level 1trauma center scenario had the most significant disparity in access between the first and fourth ADI quartiles (-54.68). Access to EGS-verified centers may vary considerably based on the program's implementation. Disadvantaged communities may be disproportionately affected by limited access. Further work to study regional needs can allow a strategic implementation of the EGS verification program to optimize outcomes while minimizing disparities. Prognostic and Epidemiological; Level IV.

Increased Neighborhood Deprivation Is Associated with Prolonged Hospital Stays After Surgical Fixation of Traumatic Pelvic Ring Injuries.

The purpose of this study was to understand the role of social determinants of health assessed by the Area Deprivation Index (ADI) on hospital length of stay and discharge destination following surgical fixation of pelvic ring fractures. A retrospective chart analysis was performed for all patients who presented to our level-I trauma center with pelvic ring injuries that were treated with surgical fixation. Social determinants of health were determined via use of the ADI, a comprehensive metric of socioeconomic status, education, income, employment, and housing quality. ADI values range from 0 to 100 and are normalized to a U.S. mean of 50, with higher scores representing greater social deprivation. We stratified our cohort into 4 ADI quartiles. Statistical analysis was performed on the bottom (25th percentile and below, least deprived) and top (75th percentile and above, most deprived) ADI quartiles. Significance was set at p < 0.05. There were 134 patients who met the inclusion criteria. Patients in the most deprived group were significantly more likely to have a history of smoking, to self-identify as Black, and to have a lower mean household income (p = 0.001). The most deprived ADI quartile had a significantly longer mean length of stay (and standard deviation) (19.2 ± 19 days) compared with the least deprived ADI quartile (14.7 ± 11 days) (p = 0.04). The least deprived quartile had a significantly higher percentage of patients who were discharged to a resource-intensive skilled nursing facility or inpatient rehabilitation facility compared with those in the most deprived quartile (p = 0.04). Race, insurance, and income were not significant predictors of discharge destination or hospital length of stay. Patients facing greater social determinants of health had longer hospital stays and were less likely to be discharged to resource-intensive facilities when compared with patients of lesser social deprivation. This may be due to socioeconomic barriers that limit access to such facilities. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Socioeconomic disadvantage is correlated with worse PROMIS outcomes following lumbar fusion

BACKGROUND CONTEXTSocioeconomic status (SES) has been associated with differential healthcare outcomes and may be proxied using the area-deprivation index (ADI). Few studies to date have investigated the role of ADI on patient-reported outcomes and clinically meaningful improvement following lumbar spine fusion surgery. PURPOSEThe purpose of this study is to investigate the role of SES on lumbar fusion outcomes using Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. STUDY DESIGN/SETTINGRetrospective review of a single institution cohort. PATIENT SAMPLEAbout 205 patients who underwent elective one-to-three level posterior lumbar spine fusion. OUTCOME MEASURESChange in PROMIS scores and achievement of minimum clinically important difference (MCID). METHODSPatients 18 years or older undergoing elective one-to-three level lumbar spine fusion secondary to spinal degeneration from January 2015 to September 2021 with minimum one year follow-up were reviewed. ADI was calculated using patient-supplied addresses and patients were grouped into quartiles. Higher ADI values represent worse deprivation. Minimum clinically important difference (MCID) thresholds were calculated using distribution-based methods. Analysis of variance testing was used to assess differences within and between the quartile cohorts. Multivariable regression was used to identify features associated with the achievement of MCID. RESULTSAbout 205 patients met inclusion and exclusion criteria. The average age of our cohort was 66±12 years. The average time to final follow-up was 23±8 months (range 12–36 months). No differences were observed between preoperative baseline scores amongst the four quartiles. All ADI cohorts showed significant improvement for pain interference (PI) at final follow-up (p<.05), with patients who had the lowest socioeconomic status having the lowest absolute improvement from preoperative baseline physical function (PF) and PI (p=.01). Only those patients who were in the lowest socioeconomic quartile failed to significantly improve for PF at final follow-up (p=.19). There was a significant negative correlation between socioeconomic level and the absolute proportion of patients reaching MCID for PI (p=.04) and PF (p=.03). However, while ADI was a significant predictor of achieving MCID for PI (p=.02), it was nonsignificant for achieving MCID for PF. CONCLUSIONSOur study investigated the influence of ADI on postoperative PROMIS scores and identified a negative correlation between ADI quartile and the proportion of patients reaching MCID. Patients in the worse ADI quartile had lower chances of reaching clinically meaningful improvement in PI. Policies focused on alleviating geographical deprivation may augment clinical outcomes following lumbar surgery.

Identifying care fragmentation in the management of non-metastatic muscle-invasive bladder cancer.

e13527 Background: Measuring care fragmentation facilitates exploration of breakdowns in cancer care delivery that may impact quality of care and patient outcomes. Bladder cancer often requires a multimodal approach of surgery, chemotherapy and radiation, increasing the risk of fragmented care. This study assesses the extent of care fragmentation across different inpatient facilities and examines patient characteristics associated with inpatient care fragmentation. Methods: We adapt the modified Herfindahl-Hirschman market concentration index to construct a Fragmentation Index (FI) capturing the distribution of a patient’s care across inpatient facilities. We calculate FI for the 15 months following diagnosis for non-metastatic muscle-invasive bladder cancer (MIBC) patients who underwent radical cystectomy from 2010-2016 and had at least 2 admissions during the study period. We use Pennsylvania Cancer Registry data linked to statewide facility discharge records to estimate patient-level multivariable regression models of the relationship between FI and patient demographics, disease features, rurality, area deprivation index (ADI), payer, and Commission on Cancer hospital (CoC-H) accreditation status. Results: Of 965 patients, 87.3% (n = 842) lived in urban areas, 8.9% in large towns and 3.8% rural. Approximately 8% had Medicaid and 5.7% had uninsured or unknown payer status. A majority (64%; n = 614) were age 60-79; 76% were men and 92% non-Hispanic White; 19.5% (n = 188) had T4 disease and 25% (n = 239) received neoadjuvant chemotherapy. Almost half of patients (45.3%; n = 437) had an FI of 0, indicating all admissions were at the same hospital. The mean FI was 0.254 for the total cohort and 0.464 for patients with FI &gt; 0. Residency in a large town or rural area was associated with 0.59 (CI 0.003—0.114) and 0.14 (CI 0.060—0.220) higher FI relative to urban areas. T4 disease was associated with 0.063 higher FI (CI 0.019—0.107) relative to &lt;T2 disease. Factors associated with lower FI included Non-White race (-0.092, CI -0.151 – -0.033) and no admissions to CoC-H (-0.138, CI -0.182 – -0.095) relative to patients admitted to at least 1 CoC-H. Patients never admitted to a CoC-H (n = 134) mostly lived in urban areas (88%) and 49% had Medicare insurance: they were disproportionately from the most disadvantaged ADI quartile in the cohort (37.3%). Conclusions: Our findings highlight that many MIBC patients receive inpatient care across at least two different hospitals. Advanced disease and patient residence in non-urban areas are associated with greater fragmentation of inpatient care. Patients who never received care at a CoC hospital experienced less fragmentation but were more likely to be relatively economically disadvantaged. Future research will investigate relationships between fragmentation and clinical outcomes to inform policy and clinical strategies aimed at optimizing patterns of care.

0428 Area Deprivation Index, Sleep Disordered Breathing and Incident Major Cardiovascular Events and Mortality in a Large Cohort

Abstract Introduction Epidemiological studies have shown a strong association between sleep disordered breathing (SDB) and increased incidence of cardiovascular morbidity and mortality, however, to date, the variation of SDB across the socioeconomic spectrum and how this variation is associated with major cardiovascular events (MACE) and mortality is unknown. Methods A retrospective cohort study was conducted using the Cleveland Clinic Sleep Laboratory Registry and included MACE-naïve adults who underwent polysomnography or home sleep apnea test. Area Deprivation Index (ADI), a biomarker of neighborhood socioeconomic disadvantage, was calculated by national rank, i.e. 25th, 50th and 75th percentiles; higher quartiles reflecting greater deprivation (ADI-Q1,2,3,4). ANOVA with pairwise testing was used to compare variables across ADI quartiles. Composite of MACE included heart failure, stroke, atrial fibrillation and myocardial Infarction or death. Cox proportional hazard regression models tested the association between ADI and SDB-measures of apnea hypopnea Index (AHI) and sleep-related hypoxia (total sleep time spent&amp;lt; 90%SaO2, T90) with MACE. Covariates included demographics, medications, smoking status, Elixhauser Comorbidity Score, and comorbidities. Censoring was sleep study date or last encounter in the electronic medical record. Asterisk (*) indicates statistical significance after pairwise testing. Interaction testing used competing risk (Fine &amp; Gray method). Results Of 72,443 patients, those living in ADI-Q4, compared to those living in ADI-Q1, were more likely to be younger (*48.9± 3.9 vs 50.4±14.2), female (*59.9% vs 40.1%), African American (*49% vs 4.9%), with lower AHI (*13.5[5.4, 34.1]vs15.1[6.2,33.1]) and lower degree of hypoxia (T90:*2.9[0.40,19.01] vs 4.4[0.50, 25.6]). Model adjusted risk for MACE or death for those in ADI-Q4 was 79% greater than ADI-Q1 (HR=1.79,95%CI:1.51-2.12,p&amp;lt; 0.0001). Likewise, increased AHI severity and T90 above median were associated with 13% and 21% increased risk of MACE or death (HR=1.13,95%CI:1.07-1.19,p&amp;lt; 0.0001; HR=1.21,95%CI:1.51-1.27,p&amp;lt; 0.001) respectively. Interactions were observed between T90 and ADI with the risk of MACE (p=0.0016) or death (p=0.0051). Conclusion Living in areas of increasing socioeconomic deprivation confers an increased risk for MACE or death. Moreover, sleep-related hypoxia seems to modify this association. ADI appears to be useful to identify populations at risk for worse cardiovascular outcomes and to inform risk stratification for targeted interventions to decreased sleep-health disparities. Support (if any)

PD32-11 IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON CARE OF URETHRAL STRICTURES: A PILOT EVALUATION OF THE AREA DEPRIVATION INDEX

You have accessJournal of UrologyCME1 Apr 2023PD32-11 IMPACT OF SOCIAL DETERMINANTS OF HEALTH ON CARE OF URETHRAL STRICTURES: A PILOT EVALUATION OF THE AREA DEPRIVATION INDEX Evan Watkins, Abimbola Ayangbesan, George Koch, Rohan Bhalla, Jackson Cabo, Helen Gambrah, Theresa Zwaschka, and Niels Johnsen Evan WatkinsEvan Watkins More articles by this author , Abimbola AyangbesanAbimbola Ayangbesan More articles by this author , George KochGeorge Koch More articles by this author , Rohan BhallaRohan Bhalla More articles by this author , Jackson CaboJackson Cabo More articles by this author , Helen GambrahHelen Gambrah More articles by this author , Theresa ZwaschkaTheresa Zwaschka More articles by this author , and Niels JohnsenNiels Johnsen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003325.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Living in socioeconomically disadvantaged neighborhoods affects health behaviors and outcomes. How neighborhood disadvantage impacts care of benign urologic disease has not been previously studied. In this pilot study, we sought to evaluate how patient-level social risk determinants impact care of urethral stricture patients. METHODS: Patients treated with urethroplasty between 9/4/2019 and 12/29/2021 were analyzed. Those with a history of urethroplasty and under the age of 18 were excluded. To evaluate neighborhood disadvantage, we used the area deprivation index (ADI), a 17-component index composed of education, employment, housing-quality, and poverty measures utilizing data from the American Community Survey. Patient addresses were geocoded and assigned a national ADI rank, with scores normalized to a percentile from 0 to 100, with higher numbers representing higher levels of disadvantage. For this analysis, patients were grouped into ADI quartiles. Multiple endoscopic procedures was defined as >2 procedures prior to urethroplasty. Impact of ADI on treatment and processes of care was analyzed utilizing univariate and multivariate models. RESULTS: 104 patients were included, with a median age 54.5 (IQR 38, 66) and ADI of 63.5 (IQR 38.8, 79.3). When separated into quartiles, 15.4%, 21.2%, 31.7% and 31.7% were in the first, second, third and fourth ADI quartiles, respectively, with higher quartiles representing increased levels of deprivation. There were no significant differences in race or insurance status by ADI quartile. Patients in the highest ADI quartile underwent significantly more endoscopic procedures prior to urethroplasty than those in the lowest, at 0 (0, 1) versus 2 (1, 4) (p=0.01). On multivariate analysis adjusting for age and insurance status, ADI quartile was associated with an increased likelihood of undergoing multiple endoscopic procedures, with OR 4.97 (95% CI 1.22-26.14) and OR 5.05 (95% CI 1.23 – 26.53) for third and fourth quartiles, respectively. A one-point increase in ADI was associated with a 2% increased risk of repeat endoscopic procedures prior to urethroplasty (OR 1.02 [95% CI 1.01 – 1.04]). CONCLUSIONS: This is the first analysis evaluating how a patient’s physical neighborhood can mediate processes of care for urethral stricture disease. We found that increased neighborhood deprivation, regardless of race or insurance status, can lead to increased endoscopic treatments and delays to urethroplasty. Utilization of this methodology can help further identify disparities in care and highlight the impact of social determinants on urologic care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e911 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Evan Watkins More articles by this author Abimbola Ayangbesan More articles by this author George Koch More articles by this author Rohan Bhalla More articles by this author Jackson Cabo More articles by this author Helen Gambrah More articles by this author Theresa Zwaschka More articles by this author Niels Johnsen More articles by this author Expand All Advertisement PDF downloadLoading ...

Abstract P260: The Association of Changes in Area Deprivation Index With Cardiometabolic Risk Factors: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Higher Area Deprivation Index (ADI) is associated with greater cardiometabolic risk. The impact of changes in ADI on the likelihood of cardiometabolic risk factors is currently unknown. Methods: Among 12,044 White and Black participants at ARIC Visit 1 (1987-89), we examined the association of cross-categories of ADI quartiles at Visit 1 and at the last visit attended up to Visit 4 (1996-98) with cardiometabolic risk factors at the time of the second ADI measurement. Cross-categories were grouped as stable low ADI (remaining in ADI quartile 1 or 2), increasing ADI (moving from ADI quartile 1 or 2 at Visit 1 to quartile 3 or 4 at follow-up), decreasing ADI (moving from ADI quartile 3 or 4 at Visit 1 to quartile 1 or 2 at follow-up) or stable high ADI (remaining in ADI quartile 3 or 4).We assessed the prevalence of hypertension, diabetes, and obesity in each group at the follow-up time point and used logistic regression to evaluate associations of changes in ADI over the 9-year period with the odds of cardiometabolic risk factors. Results: The study population had a mean age of 63 years, with 55% female and 22% Black adults. Persons with decreasing ADI had a lower prevalence of hypertension, diabetes and obesity at follow-up than those with stable high ADI, while those with increasing ADI had a higher prevalence of hypertension and obesity at follow-up than those with stable low ADI (Figure). In regression models adjusted for age and sex, decreasing ADI was linked to lower odds of hypertension, diabetes and obesity compared to stable high ADI (Table), with stronger associations for hypertension among Black adults (p interaction = 0.03). Increasing ADI was linked to modestly increased odds of obesity compared to stable low ADI. Associations were attenuated after adjustment for lifestyle measures, comorbidities and other social determinants. Conclusion: ADI changes are associated with the prevalence of cardiometabolic risk factors. Interventional studies should assess the cardiometabolic impact of targeting the built environment.

Telemedicine and health disparities: Association between the area deprivation index and primary care telemedicine utilization during the COVID-19 pandemic.

The rapid implementation of telemedicine during the COVID-19 pandemic may have exacerbated the existing health disparities. This study investigated the association between the area deprivation index (ADI), which serves as a measure of socioeconomic deprivation within a geographic area, and the utilization of telemedicine in primary care. The study data source was electronic health records. The study population consisted of patients with at least one primary care visit between March 2020 and December 2021. The primary outcome of interest was the visit modality (office, phone, and video). The exposure of interest was the ADI score grouped into quartiles (one to four, with one being the least deprived). The confounders included patient sociodemographic characteristics (e.g., age, gender, race, ethnicity, insurance coverage, marital status). We utilized generalized estimating equations to compare the utilization of telemedicine visits with office visits, as well as phone visits with video visits. The study population included 41,583 patients with 127,165 office visits, 39,484 phone visits, and 20,268 video visits. Compared to patients in less disadvantaged neighborhoods (ADI quartile = one), patients in more disadvantaged neighborhoods (ADI = two, three, or four) had higher odds of using phone visits vs office visits, lower odds of using video visits vs office visits, and higher odds of using phone visits vs video visits. Patients who resided in socioeconomically disadvantaged neighborhoods mainly relied on phone consultations for telemedicine visits with their primary care provider. Patient-level interventions are essential for achieving equitable access to digital healthcare, particularly for low-income individuals.

Abstract A019: Evaluating racial disparities in cancer survivorship via the role of area-level socioeconomic disadvantage in metropolitan Detroit

Abstract The role of socioeconomic status and race on cancer survivorship has been identified, however, the role of neighborhood disadvantage and race in cancer survivorship has not been well studied. This analysis aimed to evaluate the relationship between a comprehensive measure of neighborhood-level social disadvantage and cancer survivorship in the racially diverse population of metropolitan Detroit. We calculated overall and cancer-specific survival for 11,367 Non-Hispanic Black (NHB) and 29,481 Non-Hispanic White (NHW) individuals with breast, colorectal, lung, and prostate cancer using data from the Metropolitan Detroit Cancer Surveillance System. Neighborhood socioeconomic disadvantage was measured by the Area Deprivation Index (ADI) at the census block group level using data from the Census Bureau’s American Community Survey. Associations between ADI and survival were estimated using Cox proportional hazards mixed-effects models accounting for geographic grouping and adjusting for demographic, clinical, and treatment factors. Among all participants, an increase in ADI quartile was associated with increased overall mortality for all four cancer sites in multivariable models adjusting for race, age at diagnosis, stage, treatment, and Gleason score (prostate only). When stratifying by race, these associations remained among breast (NHW: Hazard Ratio (HR)=1.10, 95% Confidence Interval (CI) 1.05-1.15, p&amp;lt;0.0001; NHB: HR=1.14, 95% CI 1.05-1.23, p&amp;lt;0.0001), prostate (NHW: HR=1.14, 95% CI 1.09-1.20, p&amp;lt;0.0001; NHB: HR=1.08, 95% CI 1.01-1.16, p&amp;lt;0.0001), and lung cancer (NHW: HR=1.05, 95% CI 1.03-1.08, p&amp;lt;0.0001; NHB: HR=1.05, 95% CI 0.99-1.11, p=0.069), while the ADI-mortality association for colorectal cancer cases appears to be restricted only to NHWs (NHW: HR=1.09, 95% CI 1.05-1.14, p&amp;lt;0.0001; NHB: HR=1.05, 95% CI 0.98-1.12, p=0.15). Associations of cancer-specific mortality were like those of overall mortality, with a few exceptions including Hormone Receptor (HmR)+/HER2-specific mortality which was only significant in NHW women (HR=1.09, 95% CI 0.99-1.20, p=0.077), while HmR+/HER2+-specific mortality was consistent for NHW (HR=1.23, 95% CI 1.01-1.49, p=0.037) and NHB women (HR=1.21, 95% CI 0.84-1.75, p=0.31). Adjustment for ADI substantially attenuated the effects of race on overall mortality for all cancer types, except lung cancer, and significantly attenuated the effect of race on overall mortality for overall breast (proportion attenuated=54%, 95% CI 33-92%, p&amp;lt;0.0001), HmR+/HER2- breast (proportion attenuated=45%, 95% CI 19-113%, p&amp;lt;0.0001), and prostate cancer (proportion attenuated=54%, 95% CI 33-96%, p&amp;lt;0.0001); and attenuated the effects of race on cancer-specific survival only for overall breast (proportion attenuated=40%, 95% CI 16% to 87%, p&amp;lt;0.0001) and marginally for HmR+/HER2- breast cancer (proportion attenuated=24%, 95% CI -4% to 78%, p=0.094). Area-level socioeconomic disadvantage is related to the risk of cancer mortality in a racially diverse population and impacts the role of racial differences in cancer mortality. Citation Format: Natalie G. Snider, Theresa Hastert, Mrudula Nair, Madhav KC, Julie Ruterbusch, Ann Schwartz, Ed Peters, Elena Stoffel, Laura Rozek, Kristen Purrington. Evaluating racial disparities in cancer survivorship via the role of area-level socioeconomic disadvantage in metropolitan Detroit [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A019.