Measure Of Socioeconomic Disadvantage Research Articles

Correlation of Patient-Reported Social Determinants of Health With Census Tract Measures of Socioeconomic Disadvantage in Patients With GI Cancers in Eastern North Carolina.

Investigating the impact of social determinants of health (SDOHs) on cancer care in large populations relies on census estimates. Routine clinic SDOH screening provides timely patient-level information which could inform best practices. This study evaluated the correlation between patient-reported SDOH needs and population-level census tract measures. This was a retrospective cross-sectional study of a cohort of adult patients with GI malignancy screened for SDOHs such as financial insecurity, transportation, and food insecurity during initial outpatient evaluation at East Carolina University (formerly Vidant) Health Medical Center in Greenville, NC (November 2020-July 2021). Primary outcomes included number and severity of identified SDOH needs and area deprivation index (ADI) and census tract measures for each patient. Spearman rank correlations were calculated among patient-level needs and between patient-level needs and similar census tract measures. Of 112 patients screened, 58.9% self-identified as White (n = 66) and 41.1% as Black (n = 46). A total of 50.5% (n = 54) resided in a rural county. The collective median state ADI rank was 7 (IQR, 5-9). The median household income was $38,125 in US dollars (USD) (IQR, $31,436-$48,934 [USD]). Only 12.5% (n = 14) reported a moderate or severe financial need. Among reported needs, financial need moderately correlated with food insecurity (coefficient, 0.46; P < .001) and transportation (coefficient, 0.45; P < .001). Overall, census tract measures and reported needs poorly correlated. Lack of transportation correlated with percentage of households without a vehicle (coefficient, 0.18; P = .03) and limited access to healthy foods (coefficient, 0.18; P = .04). Given the poor correlation between reported and census needs, population-level measures may not accurately predict patient-reported needs. These findings highlight the importance of SDOH screening in the clinical setting to reduce health disparities and identify opportunities to improve care delivery.

Social Disadvantage and Inequity in Access to Pediatric Critical Care Services for Children Living Remote from a Children's Hospital

AbstractRegionalization of health care has created geographical distance between pediatric specialty services and children, with the potential for disparities in access to care. We investigated the association of state-level area deprivation index (S-ADI), a measure of socioeconomic disadvantage, and characteristics and outcomes in a cohort of children requiring unplanned hospital transfer to a quaternary care pediatric intensive care unit (PICU). We conducted a single-center retrospective cohort study of children requiring unplanned hospital transfer to the PICU at the University of Virginia Children's Hospital from July 1, 2019 to December 31, 2020, excluding planned transfers, transfers from another intensive care unit, and patients whose address could not be associated with an S-ADI. We collected demographic and clinical data as well as the S-ADI, an ordinal variable ranging from 1 to 10 with 10 representing the most disadvantage. We observed no differences in S-ADI based on patient sex, age, history of chronic medical conditions, or need for a medical device (tracheostomy, home ventilator, surgical feeding tube, cerebrospinal fluid shunt). We also did not observe differences in PICU or hospital length of stay based on S-ADI. We did observe for every one-point increase in S-ADI there was an associated increase of 8.6 miles (p &lt; 0.001) in patient travel distance. Among patients from a higher S-ADI area, we observed increased severity of illness on PICU admission (p = 0.02) and case fatality as compared with patients from a lower S-ADI area (11 vs. 1.9%, p = 0.038). Children traveling the farthest for subspeciality pediatric critical care at our hospital had higher measures of socioeconomic disadvantage and severity of illness.

Immigration Status and Breast Cancer Surgery Quality of Care Metrics: A Population-Level Analysis.

As immigrant women face challenges accessing health care, we hypothesized that immigration status would be associated with fewer women with breast cancer receiving surgery for curable disease, fewer undergoing breast conserving surgery (BCS), and longer wait time to surgery. A population-level retrospective cohort study, including women aged 18-70 years with Stage I-III breast cancer diagnosed between 2010 and 2016 in Ontario was conducted. Multivariable analysis was performed to assess odds of undergoing surgery, receiving BCS and wait time to surgery. A total of 31,755 patients were included [26,253 (82.7%) Canadian-born and 5502 (17.3%) immigrant women]. Immigrant women were younger (mean age 51.6 vs. 56.1 years) and less often presented with Stage I/II disease (87.4% vs. 89.8%) (both p < .001). On multivariable analysis, there was no difference between immigrant women and Canadian-born women in odds of undergoing surgery [Stage I OR 0.93 (95% CI 0.79-1.11), Stage II 1.04 (0.89-1.22), Stage III 1.22 (0.94-1.57)], receiving BCS [Stage I 0.93 (0.82-1.05), Stage II 0.96 (0.86-1.07), Stage III 1.00 (0.83-1.22)], or wait time [Stage I 0.45 (-0.61-1.50), Stage II 0.33 (-0.86-1.52), Stage III 3.03 (-0.05-6.12)]. In exploratory analysis, new immigrants did not have surgery more than established immigrants (12.9% vs. 10.1%), and refugee women had longer wait time compared with economic-class immigrants (39.5 vs. 35.3 days). We observed differences in measures of socioeconomic disadvantage and disease characteristics between immigrant and Canadian-born women with breast cancer. Upon adjusting for these factors, no differences emerged in rate of surgery, rate of BCS, and time to surgery. The lack of disparity suggests barriers to accessing basic components of breast cancer care may be mitigated by the universal healthcare system in Canada.

Associations of U.S. hospital closure (2007-2018) with area socioeconomic disadvantage and racial/ethnic composition

PurposeTo examine whether hospital closure is associated with high levels of area socioeconomic disadvantage and racial/ethnic minority composition. MethodsPooled cross-sectional analysis (2007–2018) of 6467 U.S. hospitals from the American Hospital Association’s Annual Survey, comparing hospital population characteristics of closed hospitals to all remaining open hospitals. We used multilevel mixed-effects logistic regression models to assess closure as a function of population characteristics, including area deprivation index ([ADI], a composite measure of socioeconomic disadvantage), racial/ethnic composition, and rural classification, nesting hospitals within hospital service areas (HSAs) and hospital referral regions. Secondary analyses examined public or private hospital type. ResultsOverall, 326 (5.0%) of 6467 U.S. hospitals closed during the study period. In multivariable models, hospitals in HSAs with a higher burden of socioeconomic disadvantage (per 10% above median ADI ZIP codes, AOR 1.05; 95% CI, 1.01–1.09) and Black Non-Hispanic composition (highest quartile, AOR 4.03; 95% CI, 2.62–6.21) had higher odds of closure. We did not observe disparities in closure by Hispanic/Latino composition or rurality. Disparities persisted for Black Non-Hispanic communities, even among HSAs with the lowest burden of disadvantage. ConclusionsDisproportionate hospital closure in communities with higher socioeconomic disadvantage and Black racial composition raises concerns about unequal loss of healthcare resources in the U.S.

Area-Level Socioeconomic Disadvantage and Health Care Spending

Publicly available, US Census-based composite measures of socioeconomic disadvantage are increasingly being used in a wide range of clinical outcomes and health services research. Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) are 2 of the most commonly used measures. There is also early interest in incorporating area-level measures to create more equitable alternative payment models. To review the evidence on the association of ADI and SVI with health care spending, including claims-based spending and patient-reported barriers to care due to cost. A systematic search for English-language articles and abstracts was performed in the PubMed, Web of Science, Embase, and Cochrane databases (from inception to March 1, 2023). Peer-reviewed articles and abstracts using a cross-sectional, case-control, or cohort study design and based in the US were identified. Data analysis was performed in March 2023. This review included 24 articles and abstracts that used a cross-sectional, case-control, or cohort study design. In 20 of 24 studies (83%), ADI and SVI were associated with increased health care spending. No association was observed in the 4 remaining studies, mostly with smaller sample sizes from single centers. In adjusted models, the increase in spending associated with higher ADI or SVI residence was $574 to $1811 for index surgical hospitalizations, $3003 to $24 075 for 30- and 90-day episodes of care, and $3519 for total annual spending for Medicare beneficiaries. In the studies that explored mechanisms, postoperative complications, readmission risk, and poor primary care access emerged as health care system-related drivers of increased spending. The findings of this systematic review suggest that both ADI and SVI can play important roles in efforts to understand drivers of health care spending and in the design of payment and care delivery programs that capture aspects of social risk. At the health care system level, higher health care spending and poor care access associated with ADI or SVI may represent opportunities to codesign interventions with patients from high ADI or SVI areas to improve access to high-value health care and health promotion more broadly.

COVID-19, Online Learning, and Absenteeism in Detroit

How much school students attend is a powerful indicator of their well-being and a strong predictor of their future success in school. Prior research has documented the myriad in-school and out-of-school factors that contribute to high levels of student absenteeism, many emerging from the root causes of poverty and disengagement. The shift to online learning during the COVID-19 pandemic likely disrupted prior barriers to attendance and may have created new ones. This sequential explanatory mixed-methods study examined student absenteeism during the 2020–2021 school year in Detroit. We used administrative data to show whether and how attendance patterns changed, and we linked family survey and interview data to explain those patterns. We found that 70% of students were chronically absent, with 40% of parents reporting that computer problems contributed to absenteeism. While measures of socioeconomic disadvantage and computer/internet issues were associated with lower attendance and higher probability of chronic absenteeism, reported levels of hardship during the pandemic were not. Despite significant investment in technology, the district’s strategies for engaging students were not sufficient in overcoming economic hardships and the new challenges of online learning.

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.

Impact of Socioeconomic Disparities on Outcomes in Adults Undergoing Allogeneic Hematopoietic Cell Transplantation for Acute Myeloid Leukemia

Introduction: It is increasingly recognized that racial and socioeconomic disparities play an important prognostic role and contribute to differences in outcomes in adults receiving chemotherapy for acute myeloid leukemia (AML). Structural racism has also been implicated in limiting access to allogeneic hematopoietic cell transplantation (HCT). However, it is unclear to what degree racial and socioeconomic disparities impact post-HCT outcomes of patients with AML in contemporary practice. To address this uncertainty, we investigated the impact of socioeconomic, racial, and non-biologic disparities on outcomes in a large cohort of adults with AML undergoing allogeneic HCT while in first or second morphologic remission. Methods: We identified 1,004 adults with AML (2022 ICC criteria) who underwent allogeneic HCT between 5/2006 and 10/2021 at a single large university-affiliated cancer center. Data was collected on each patient's individual socioeconomic status (SES), including occupation, insurance type, and education attainment. Distance traveled, marital status, household size, country of birth, and religious affiliation were also recorded. Each occupation was classified by the International Socio-Economic Index (ISEI), a standard index of occupational status. Area-level SES was analyzed through the Area Deprivation Index (ADI), a validated measure of socioeconomic disadvantage which corresponds to U.S. census tract measurements. Collected HCT variables include the AML treatment-related mortality score (TRM), pre-HCT flow cytometric MRD status, HLA donor status, cytogenetic risk, conditioning regimen intensity, and incidence of severe acute and chronic graft-vs-host disease. Measured outcomes include non-relapse mortality (NRM), overall survival (OS), relapse, and relapse free survival (RFS). Cause-specific hazard models were used for univariate and multivariable regression analysis and C-statistics were calculated to quantify each model's ability to predict outcomes. Results: In univariate analysis, none of the socioeconomic or non-biologic factors were significantly associated with NRM, and all had poor predictive performance, with C-statistics not exceeding 0.53 for: marital status, larger household size (i.e., patients with children), distance traveled, ISEI, ADI, insurance status, educational attainment, or country of birth. TRM score (P&amp;lt;0.001), non-myeloablative conditioning (P&amp;lt;0.001), reduced intensity conditioning (P&amp;lt;0.001), CR2 (P=0.017) and marital status (P=0.014) were significantly associated with NRM in a multivariable model, but predictive performance of this model was only fair (C=0.69; Table 1). Marital status was only associated with NRM after multivariable adjustment but not on univariate evaluation, possibly because married patients were, on average, older (P&amp;lt;0.001), more likely to be male (P&amp;lt;0.001), and have higher occupational status/ISEI (P&amp;lt;0.001) and TRM scores (P&amp;lt;0.001), with age and sex as likely confounders (Table 2). African American patients (n=14) were found to have worse NRM in both univariate (P=0.036) and multivariate (P=0.024) models, consistent with previously identified racial/ethnic disparities in AML cohorts. Similar results were found for SES and non-biologic variables in regards to OS, relapse, and RFS. Notable exceptions after multivariable adjustment include: ADI was significantly associated with OS (P=0.036) and RFS (P=0.044) and marital status was not significantly associated with OS or relapse. Additional analyses demonstrated that ISEI and ADI were not associated with increased TRM or HLA donor status. Finally, distance traveled decreased in HCT recipients post-2013 (P&amp;lt;0.003), though the number of AML-related transplants remained unchanged. Conclusion: In this retrospective, single center analysis, socioeconomic and non-biologic factors had very limited impact on outcomes following allografting for adults with AML. While reassuring, patients able to undergo allogeneic HCT are highly selected (e.g. need for caregiver, insurance, etc.) possibly accounting for this finding, as could integrated, multidisciplinary cancer care networks and longitudinal care coordination post-HCT. Further research is needed to investigate disparities among HCT-eligible patients and improve access to HCT with a focus on reducing racial/ethnic disparities.

Social determinants of health in patients undergoing hemiarthroplasty: are they associated with medical complications, healthcare utilization, and payments for care?

Social determinants of health (SDOH) have previously been shown to impact orthopedic surgery outcomes. This study assessed whether greater socioeconomic disadvantage in patients undergoing hemiarthroplasty following femoral neck fracture was associated with differences in (1) medical complications, (2) emergency department (ED) utilization, (3) readmission rates, and (4) payments for care. A US nationwide database was queried for hemiarthroplasties performed between 2010 and 2020. Area Deprivation Index (ADI), a validated measure of socioeconomic disadvantage reported on a scale of 0-100, was used to compare two cohorts of greater and lesser deprivation. Patients undergoing hemiarthroplasty from high ADI (95% +) were 1:1 propensity score matched to a comparison group of lower ADI (0-94%) while controlling for age, sex, and Elixhauser Comorbidity Index. This yielded 75,650 patients evenly distributed between the two cohorts. Outcomes studied were 90-day medical complications, ED utilizations, readmissions, and payments for care. Multivariate logistic regression models were utilized to calculate odds ratios (ORs) of the relationship between ADI and outcomes. p Values < 0.05 were significant. Patients of high ADI developed greater medical complications (46.74% vs. 44.97%; OR 1.05, p = 0.002), including surgical site infections (1.19% vs. 1.00%; OR 1.20, p = 0.011), cerebrovascular accidents (1.64% vs. 1.41%; OR 1.16, p = 0.012), and respiratory failures (2.27% vs. 2.02%; OR 1.13, p = 0.017) compared to patients from lower ADIs. Although comparable rates of ED visits (2.92% vs. 2.86%; OR 1.02, p = 0.579), patients from higher ADI were readmitted at diminished rates (10.57% vs. 11.06%; OR 0.95, p = 0.027). Payments were significantly higher on the day of surgery ($7,570 vs. $5,974, p < 0.0001), as well as within 90days after surgery ($12,700 vs. $10,462, p < 0.0001). Socioeconomically disadvantaged patients experience increased 90-day medical complications and payments, similar ED utilizations, and decreased readmissions. These findings can be used to inform healthcare providers to minimize disparities in care. III.

Association of Neighborhood Socioeconomic Deprivation With Utilization and Costs of Anterior Cervical Discectomy and Fusion.

A retrospective analysis. The aim of our study was to analyze the association of Area Deprivation Index (ADI) with the utilization and costs of elective anterior cervical discectomy and fusion (ACDF) surgery. ADI, a comprehensive neighborhood-level measure of socioeconomic disadvantage, has been shown to be associated with worse perioperative outcomes in a variety of surgical settings. The Maryland Health Services Cost Review Commission Database was queried to identify patients who underwent primary elective ACDF between 2013 and 2020 in the state. Patients were stratified into tertiles by ADI, from least disadvantaged (ADI1) to most disadvantaged (ADI3). The primary endpoints were ACDF utilization rates per 100,000 adults and episode-of-care total costs. Univariable and multivariable regression analyses were performed. A total of 13,362 patients (4984 inpatient and 8378 outpatient) underwent primary ACDF during the study period. In our study, there were 2,401 (17.97%) patients residing in ADI1 neighborhoods (least deprived), 5974 (44.71%) in ADI2, and 4987 (37.32%) in ADI3 (most deprived). Factors associated with increased surgical utilization were increasing ADI, outpatient surgical setting, non-Hispanic ethnicity, current tobacco use, and diagnoses of obesity and gastroesophageal reflux disease. Factors associated with lower surgical utilization were: non-white race, rurality, Medicare/Medicaid insurance status, and diagnoses of cervical disk herniation or myelopathy. Factors associated with higher costs of care were increasing ADI, older age, Black/African American race, Medicare or Medicaid insurance, former tobacco use, and diagnoses of ischemic heart disease and cervical myelopathy. Factors associated with lower costs of care were outpatient surgical setting, female sex, and diagnoses of gastroesophageal reflux disease and cervical disk herniation. Neighborhood socioeconomic deprivation is associated with increased episode-of-care costs in patients undergoing ACDF surgery. Interestingly, we found greater utilization of ACDF surgery among patients with higher ADI. 3.

Socioeconomic Disparities in Patients Receiving Intravitreal Injections for Age-Related Macular Degeneration Amid the COVID-19 Pandemic.

Purpose: To determine the effects of socioeconomic factors on visit adherence and the resultant visual outcomes for patients receiving intravitreal injections for neovascular age-related macular degeneration during the COVID-19 pandemic. Methods: In this retrospective case-control study, medical records were reviewed to collect appointment attendance, age, sex, self-reported race/ethnicity, primary language, marital status, insurance, distance from clinic, and Area Deprivation Index (ADI), a measure of socioeconomic disadvantage. Multivariate regression models were created to determine differences in socioeconomic factors between individuals who attended (show group) and those who did not attend (no-show group) appointments. Results: The study enrolled 126 patients in the show group and 115 in the no-show group. On univariate analysis, nonadherence was significantly higher in non-White patients than in White patients (P = .04), urban sites than in suburban sites (P = 1.7 × 10-4), and non-English-speaking patients than in English-speaking patients (P = 4.0 × 10-3). The associations remained significant in multivariate analysis for non-English-speaking patients (P = .03) and urban-site patients (P = .01) after adjusting for age, sex, self-reported race/ethnicity, primary language, marital status, insurance, distance from clinic, site of visit, and ADI. At 6 months and 1 year, a 1-, 2-, and 3-line vision loss was significantly higher in the no-show group than in the show group on univariate and multivariate analysis after adjusting for age, sex, race, lens status, and presence of glaucoma and diabetic retinopathy. Conclusions: Non-English-speaking patients and urban-based patients were less likely to present for intravitreal injection appointments during the initial peak of the COVID-19 pandemic. This disparity translated to worse vision outcomes at 6 months and 1 year.

Firearm Assaults in Communities: The Impact of COVID-19 Lockdown.

Firearm violence has increased nationwide, with recent surges linked to the COVID-19 pandemic. We measured traumatic assault trends at our urban Level I trauma center and assessed rates of firearm violence over time and pre/post local COVID-19 lockdown based on levels of socioeconomic disadvantage. We conducted a retrospective review (2016-2022) of assault patients 16years and older. Demographics and hospital outcomes were assessed by assault mechanism (firearm, knife, blunt). Patient address was correlated to Area Deprivation Index (ADI), a measure of socioeconomic disadvantage. COVID-19 lockdown onset was defined as initial date of lockdown (3/19/2020). Trend and time-series analyses compared all assault mechanisms and firearm-specific assaults pre/post-lockdown. Poisson regression assessed firearm assault risk. Of the 1583 total assaults, firearm patients (n = 335) were younger (median 29years), had longer hospital stays (median 2days), and greater mortality (12%) than other mechanisms. The 2years post-lockdown had significantly more firearm assaults (27% vs 15% pre-lockdown, P < .001) and time-series analysis found this abrupt and significant increase in firearm assaults occurred at lockdown onset (P = .01). Also post-lockdown, the rate of firearm assaults increased by 10% for every unit increase in socioeconomic deprivation (P < .01). There was no change in assault type by race/ethnicity. Firearm assaults increased dramatically immediately post-COVID lockdown at our center and have maintained higher rates through 2022. Greater ADI was associated with increasing firearm assaults and has magnified post-lockdown, demonstrating lower socioeconomic groups are disproportionately and increasingly affected by firearm violence.

Impact of area deprivation index on clinical outcomes of adults with acute myeloid leukemia at a rural academic medical center.

e18615 Background: Living in a disadvantaged neighborhood may lead to survival disparities amongst patients with acute myeloid leukemia (AML). The Area Deprivation Index (ADI) is a measure of socioeconomic disadvantage by decile used to find discrepancies in healthcare outcomes. Increasing ADI negatively impacts ovarian cancer survival, with each decile increase in state or national ADI corresponding with a 9-10% greater risk of death (Hufnagel D et al., Cancer Epidemiology 2021). Higher ADI was correlated with decreased rates of adjuvant therapy for localized pancreatic cancer (Mora et al., American Journal of Surgery 2021). There are no American studies on ADI and AML. This study aims to identify the impact of socioeconomic disadvantage on survival outcomes for patients with AML in a rural population. Methods: A retrospective review of 180 adults with AML treated at Dartmouth Hitchcock Medical Center (DHMC) between 1/1/2010 - 12/31/2020. Patients with APML, primary treatment outside of DHMC, and those who opted for comfort measures only at diagnosis were excluded. Demographic data, including cytogenetics, treatment type, response to treatment, and survival at one year were recorded. Addresses from the medical record were used to determine state-level ADI using the University of Wisconsin Neighborhood Atlas. Results: Eighty-nine patients were included (64% male; 93% White). Median age was 65 years. Fifty-one patients (57%) had high risk disease, 31 intermediate risk (35%), 5 favorable risk (6%), and unknown risk for 2 (2%). Sixty-two patients (70%) received intensive chemotherapy [7+3] while 27 (30%) received less intensive therapy [hypomethylating therapy]. Twenty-six patients (29%) underwent transplantation. ADI decile was not associated with survival (p = 0.62). Furthermore, when ADI was divided into three groups (deciles 1-3, 4-6, 7-10) there was no difference in survival (p = 0.345). There was no effect of travel distance to DHMC [median 81 minutes] on OS (p = 0.619). There was a significant difference in survival outcomes between the two treatment types (p = 0.001), with median 25.7 vs. 7.1 months in the intensive vs. less intensive groups. This survival advantage was seen on multivariate analysis (p = 0.03). Females had better OS compared to males (p = 0.02) and older age was a negative predictor of outcome (p = 0.007). In those who achieved remission with induction, transplant led to improved survival (p = 0.04). Conclusions: There was no significant difference in treatment outcomes based on ADI, potentially due to equitable quality of care delivered regardless of socioeconomic disparities. This may be due to strong nurse navigation, social work support, specialists from the primary site who provide care in the community, and access to transplantation. Future studies to delineate the impact of various interventions for those with high ADI may be beneficial in treatment planning.

Predictors of cancer center-based follow-up among pediatric and adolescent/young adult cancer survivors.

10055 Background: Though guidelines recommend lifelong follow-up for pediatric and adolescent/young adult (AYA) cancer survivors, this has been challenging to implement in clinical practice. We constructed an institutional cohort of pediatric/AYA cancer survivors in order to evaluate follow-up patterns and identify predictors of cancer center-based follow-up. We hypothesized that follow-up would be lower for patients with greater individual- and area-level socioeconomic disadvantage and longer time since treatment. Methods: This retrospective cohort study used EHR data at an academic medical center. We included all patients who completed cancer treatment between 2010-2019 and were aged 0-29 years at last treatment date. Treatment was defined by diagnosis/procedure codes and medication records for chemotherapy, radiation, stem cell transplant, and cancer surgery. The primary outcome of cancer center-based follow-up was defined by clinic visits in an oncology department through 12/31/2022. Patients who died were excluded after the date of death. Multivariate logistic regression models (overall, age 0-19, age 20-29) evaluated the association of follow-up with age, sex, race/ethnicity, treatment intensity, insurance type, primary language, distance to cancer center, and area deprivation index (ADI, a composite measure of socioeconomic disadvantage). Results: 2210 patients were included with an overall rate of cancer center-based follow-up that decreased from 94% 1 year after treatment to 61% at 2-3 years, 45% at 4-5 years, and 35% at 6-7 years. Follow-up was not significantly associated with race/ethnicity, insurance type, primary language, or ADI for overall or age-specific cohorts. Patients &gt;100 miles away had lower odds of follow-up. Increasing age was associated with decreased odds of follow-up, and this trend persisted over time since treatment (Table). Conclusions: Patterns of decreased pediatric/AYA cancer survivor follow-up were largely predicted by age and time since treatment. Further work is ongoing to understand drivers of follow-up disparities, including transfers of care and insurance type among AYA patients and the role of community support and telemedicine in healthcare access and health promotion. [Table: see text]

Impact of neighborhood deprivation and social vulnerability on long-term outcomes and desire for revision in patients with craniosynostosis.

The authors utilized the area deprivation index (ADI), a validated composite measure of socioeconomic disadvantage, and the social vulnerability index (SVI) to examine whether differences in neighborhood deprivation impact interventions and outcomes among patients with craniosynostosis. Patients who underwent craniosynostosis repair between 2012 and 2017 were included. The authors collected data about demographic characteristics, comorbidities, follow-up visits, interventions, complications, desire for revision, and speech, developmental, and behavioral outcomes. National percentiles for ADI and SVI were determined using zip and Federal Information Processing Standard (FIPS) codes. ADI and SVI were analyzed by tertile. Firth logistic regressions and Spearman correlations were used to assess associations between ADI/SVI tertile and outcomes/interventions that differed on univariate analysis. Subgroup analysis was performed to examine these associations in patients with nonsyndromic craniosynostosis. Differences in length of follow-up among the nonsyndromic patients in the different deprivation groups were assessed with multivariate Cox regressions. In total, 195 patients were included, with 37% of patients in the most disadvantaged ADI tertile and 20% of patients in the most vulnerable SVI tertile. Patients in more disadvantaged ADI tertiles were less likely to have physician-reported desire (OR 0.17, 95% CI 0.04-0.61, p < 0.01) or parent-reported desire (OR 0.16, 95% CI 0.04-0.52, p < 0.01) for revision, independent of sex and insurance status. In the nonsyndromic subgroup, inclusion in a more disadvantaged ADI tertile was associated with increased odds of speech/language concerns (OR 4.42, 95% CI 1.41-22.62, p < 0.01). There were no differences in interventions received or outcomes among SVI tertiles (p ≥ 0.24). Neither ADI nor SVI tertile was associated with risk of loss to follow-up among nonsyndromic patients (p ≥ 0.38). Patients from the most disadvantaged neighborhoods may be at risk for poor speech outcomes and different standards of assessment for revision. Neighborhood measures of disadvantage represent a valuable tool to improve patient-centered care by allowing for modification of treatment protocols to meet the unique needs of patients and their families.

Targeting Diabetes Prevention to More Disadvantaged Groups Improves Cost-Effectiveness: Implications of Inequality in Type 2 Diabetes From Theoretical Interventions

ObjectivesTo determine the effect of socioeconomic status on efficacy and cost thresholds at which theoretical diabetes prevention policies become cost-effective. MethodsWe designed a life table model using real-world data that captured diabetes incidence and all-cause mortality in people with and without diabetes by socioeconomic disadvantage. The model used data from the Australian diabetes registry for people with diabetes and the Australian Institute of Health and Welfare for the general population. We simulated theoretical diabetes prevention policies and estimated the threshold at which they would be cost-effective and cost saving, overall, and by socioeconomic disadvantage, from the public healthcare perspective. ResultsFrom 2020 to 2029, 653 980 people were projected to develop type 2 diabetes, 101 583 in the least disadvantaged quintile and 166 744 in the most. Theoretical diabetes prevention policies that reduce diabetes incidence by 10% and 25% would be cost-effective in the total population at a maximum per person cost of Australian dollar (AU$) 74 (95% uncertainty interval: 53-99) and AU$187 (133-249) and cost saving at AU$26 (20-33) and AU$65 (50-84). Theoretical diabetes prevention policies remained cost-effective at a higher cost in the most versus least disadvantaged quintile (eg, a policy that reduces type 2 diabetes incidence by 25% would be cost-effective at AU$238 [169-319] per person in the most disadvantaged quintile vs AU$144 [103-192] in the least). ConclusionsPolicies targeted at more disadvantaged populations will likely be cost-effective at higher costs and lower efficacy compared to untargeted policies. Future health economic models should incorporate measures of socioeconomic disadvantage to improve targeting of interventions.

Lower Neighborhood Socioeconomic Status May Influence Medical Complications, Emergency Department Utilization, and Costs of Care After 1- to 2-Level Lumbar Fusion.

Retrospective Case-Control Study. The objectives were to determine whether patients from poor social determinants of health, undergoing primary 1- to 2-level lumbar fusion, demonstrate differences in (1) medical complications, (2) emergency department (ED) utilizations, (3) readmission rates, and (4) costs of care. Measures of socioeconomic disadvantage may enable improved targeting and prevention of potentially increased health care utilization. The Area Deprivation Index (ADI) is a validated index of 17 census-based markers of material deprivation and poverty. A retrospective query of the 2010-2020 PearlDiver database was performed for primary 1- to 2-level lumbar fusions for degenerative lumbar pathology. High ADI (scale: 0-100) is associated with a greater disadvantage. Patients with high ADI (90%+) were 1:1 propensity score matched to controls (ADI: 0-89%) by age, sex, and Elixhauser Comorbidity Index. This yielded 34,442 patients, evenly matched between cohorts. Primary outcomes were to compare 90-day complications, ED utilizations, readmissions, and costs of care. Multivariable logistic regression models computed the odds ratios (OR) of ADI on complications, ED utilizations, and readmissions. P -values <0.05 were significant. Patients with a high ADI incurred higher rates and odds of developing respiratory failures (1.17% vs. 0.87%; OR: 1.35, P =0.005). Acute kidney injuries (2.61% vs. 2.29%; OR: 1.14, P =0.056), deep venous thromboses (0.19% vs. 0.17%; OR: 1.14, P =0.611), cerebrovascular accidents (1.29% vs. 1.31%; OR: 0.99, P =0.886), and total medical complications (23.35% vs. 22.93%; OR: 1.02, P =0.441) were similar between groups. High ADI patients experienced higher rates and odds of ED visits within 90 days (9.67% vs. 8.91%; OR: 1.10, P =0.014) and overall 90-day expenditures ($54,459 vs. $47,044; P <0.001). Socioeconomically disadvantaged patients have increased rates and odds of respiratory failure within 90 days. ED utilization within 90 days of surgery was higher in socioeconomically disadvantaged patients. Social determinants of health could be used to inform health care policy and improve postdischarge care. Level III.

Race, Sex, and Neighborhood Socioeconomic Disparities in Ablation of Ventricular Tachycardia Within a National Medicare Cohort.

Background Ventricular tachycardia (VT) ablation significantly improves our ability to control VT, yet little is known about whether disparities exist in delivery of this technology. Methods and Results Using a national 100% Medicare inpatient data set of beneficiaries admitted with VT from January 1, 2014, through November 30, 2014, multivariable logistic regression techniques were used to examine the sociodemographic and clinical characteristics associated with receiving ablation. Census block group-level neighborhood socioeconomic disadvantage was measured for each patient by the Area Deprivation Index, a composite measure of socioeconomic disadvantage consisting of education, income, housing, and employment factors. Among 131 645 patients admitted with VT, 2190 (1.66%) received ablation. After adjustment for comorbidities, hospital characteristics, and sociodemographics, female sex (odds ratio [OR], 0.75 [95% CI, 0.67-0.84]), identifying as Black race (OR, 0.75 [95% CI, 0.62-0.90] compared with identifying as White race), and living in a highly socioeconomically disadvantaged neighborhood (national Area Deprivation Index percentile of >85%) (OR, 0.81 [95% CI, 0.69-0.95] versus Area Deprivation Index ≤85%) were associated with significantly lower odds of receiving ablation. Conclusions Female patients, patients identifying as Black race, and patients living in the most disadvantaged neighborhoods are 19% to 25% less likely to receive ablation during hospitalization with VT. The cause of and solutions for these disparities require further investigation.

LBMON236 Investigating The Effect Of Social Vulnerability Index On Fibroid Recurrence And Metabolic Dysfunction

Abstract Fibroids and metabolic dysfunction disproportionately affect women of color. We have previously shown that recurrent fibroids and metabolic dysfunction lead to increased healthcare utilization. The impact of socioeconomic factors on access to care for these women is poorly understood. Our objective was to evaluate the social vulnerability indices of women with fibroids with and without metabolic dysfunction, and determine the association of social vulnerability with fibroid recurrence. We conducted a retrospective cohort study of 918 geocoded patients who underwent myomectomy at a tertiary health care system. The primary exposure was the Social Vulnerability Index (SVI), a measure of socioeconomic disadvantage developed by the CDC with four thematic subgroups (socioeconomic status, household composition, Race/Ethnicity/Language, and Housing/Transportation). The primary outcome was clinically significant fibroid recurrence after initial myomectomy, defined as symptomatic fibroids requiring re-imaging or surgery. SVI was analyzed as an overall score and by quartiles. Models were adjusted for age, race, and insurance status, with metabolic dysfunction analyzed separately as a covariate. Patients were classified as having metabolic dysfunction (MD) if they met any 2 of 5 WHO or NCEP ATP III criteria for metabolic syndrome with BMI as proxy for waist circumference. Appropriate parametric and non-parametric tests and logistic regression were used to determine the association of SVI with fibroid recurrence. The mean SVI score for the cohort was 0.58 (SD 0.31). Mean SVI scores for patients with and without clinically significant fibroid recurrence were similar at 0.56 (SD 0.30) and 0.57 (SD 0.30), respectively. There remained no association between mean SVI score and odds of fibroid recurrence in adjusted models (OR 0.35, CI 0.10-1.24, p 0.11). Notably, there was a decreased rate of radiologic fibroid recurrence in the highest quartile of SVI (p=0. 011) and an increased rate in the third quartile (p=0. 015). When isolating the individual themes of the SVI index, there was a significant decrease in surgical and radiologic fibroid recurrence in individuals with the highest quartile of minority and language vulnerability (p=0. 03). The odds of metabolic dysfunction increased by 2.9 with each unit increase in SVI (OR 2.85, CI 1.34-6. 07, p 0. 006) after adjusting for age, race, and insurance status. We report that while patients with a higher SVI have increased risk of metabolic dysfunction, this does not translate to higher rates of clinical significant fibroid recurrence. Higher SVI is associated with lower resourced settings and reduced access to care and can therefore be used as a starting point for public health policy. SVI should be considered when studying fibroids, and may illuminate potential barriers in access to care for fibroid recurrence in patients with a history of myomectomy. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

A traumatic pandemic: High acuity pediatric trauma in the COVID19 era

ObjectiveGaps remain in our understanding on how COVID19 affects trends in pediatric trauma, the leading cause of mortality and morbidity during childhood and adolescence. MethodsWe compared high acuity trauma visits (requiring admission, surgery, or fatality) presenting between March through February 2021 to corresponding months in 2017-2019. We evaluated the differences in mechanisms of injury, age, and Area Deprivation Index (ADI), a measure of socioeconomic disadvantage, during this time period. Data were analyzed using longitudinal time series analyses and t-tests. ResultsOf 687 traumas presenting from March 2020 through February 2021, 322 were high acuity traumas. High acuity traumas declined significantly to a nadir of 16 in April 2020. High acuity traumas increased and surpassed previous years to a peak of 40 visits in August 2020 and from October through December 2020. There were more visits for high acuity assaults and confirmed or suspected physical child abuse but fewer for falls, drownings, and motor vehicle accidents from March to August 2020 and from October through December 2020 compared to prior years. High acuity assaults and physical child abuse cases on average were from the most disadvantaged areas, and physical child abuse patients were younger during the peak of the Pandemic compared to Pre-Pandemic months. ConclusionThis analysis provides insight into how the COVID19 pandemic has affected high acuity trauma in an inner-city pediatric population. Findings may be used to guide public health measures on safety and injury prevention as the pandemic continues.