Neighborhood Socioeconomic Disadvantage Research Articles

Impact of Socioeconomic Factors and Health Insurance Coverage on Out-of-Pocket Health Expenditure among Ghanaian Women: Implications for Health Financing Policy

Background. The cost of health financing is an age-long social challenge in resource-constrained settings. Out-of-pocket (OOP) health spending adversely affects maternal healthcare provisions and use, making health insurance one of the most effective social interventions. Objective. The purpose of this research was to study the effect of OOP health expenditure on socioeconomic factors and health insurance coverage among Ghanaian women. Materials and Methods. Secondary statistical data pulled out from Ghana Demographic and Health Survey (GDHS)—2014 was investigated. A sample of 9,396 women whose ages ranged from 15 to 49 years was studied. We used marginal predictive model to examine the interaction effect between socioeconomic factors and health insurance coverage on OOP health expenditure. The significance level was determined at 5%. Results. Overall, about 41.9% (95% CI: 39.4%−44.4%) of Ghanaian women reported OOP health expenditure for drugs and services. Amongst those covered by health insurance, this was 37.9% (95% CI: 35.3%−44.4%). The marginal interaction effects of OOP health expenditure were higher for women in the lowest neighborhood socioeconomic disadvantage group (42.6%) than those in the highest neighborhood socioeconomic disadvantage group (26.0%) who were covered by health insurance. In addition, the marginal interaction effects of OOP health expenditure were found to be greater among women who had higher education (43.8%) compared with those who had no formal education (34.0%) who were covered by health insurance. Furthermore, the marginal interaction effects of OOP health expenditure were higher for rural (39.0%), than their urban counterpart (36.6.0%) who were under the covering of health insurance. Conclusion. There is a gap in health insurance coverage, which leads to increased OOP health expenditure. The OOP health expenditure effect was more concentrated among high socioeconomic women with health insurance. The healthcare system’s stakeholders should implement policies aimed at eliminating OOP health expenditure for maternal health services.

Financial hardship and neighborhood socioeconomic disadvantage in long-term childhood cancer survivors.

Long-term survivors of childhood cancer face elevated risk for financial hardship. We evaluate whether childhood cancer survivors live in areas of greater deprivation and the association with self-reported financial hardships. We performed a cross-sectional analysis of data from the Childhood Cancer Survivor Study between 1970 and 1999 and self-reported financial information from 2017 to 2019. We measured neighborhood deprivation with the Area Deprivation Index (ADI) based on current zip code. Financial hardship was measured with validated surveys that captured behavioral, material and financial sacrifice, and psychological hardship. Bivariate analyses described neighborhood differences between survivors and siblings. Generalized linear models estimated effect sizes between ADI and financial hardship adjusting for clinical factors and personal socioeconomic status. Analysis was restricted to 3475 long-term childhood cancer survivors and 923 sibling controls. Median ages at time of evaluation was 39 years (interquartile range [IQR] = 33-46 years and 47 years (IQR = 39-59 years), respectively. Survivors resided in areas with greater deprivation (ADI ≥ 50: 38.7% survivors vs 31.8% siblings; P < .001). One quintile increases in deprivation were associated with small increases in behavioral (second quintile, P = .017) and psychological financial hardship (second quintile, P = .009; third quintile, P = .014). Lower psychological financial hardship was associated with individual factors including greater household income (≥$60 000 income, P < .001) and being single (P = .048). Childhood cancer survivors were more likely to live in areas with socioeconomic deprivation. Neighborhood-level disadvantage and personal socioeconomic circumstances should be evaluated when trying to assist childhood cancer survivors with financial hardships.

Exposure to community violence as a mechanism linking neighborhood socioeconomic disadvantage and neural responses to reward.

A growing literature links socioeconomic disadvantage and adversity to brain function, including disruptions in reward processing. Less research has examined exposure to community violence (ECV) as a specific adversity related to differences in reward-related brain activation, despite the prevalence of community violence exposure for those living in disadvantaged contexts. The current study tested whether ECV was associated with reward-related ventral striatum (VS) activation after accounting for familial factors associated with differences in reward-related activation (e.g. parenting and family income). Moreover, we tested whether ECV is a mechanism linking socioeconomic disadvantage to reward-related activation in the VS. We utilized data from 444 adolescent twins sampled from birth records and residing in neighborhoods with above-average levels of poverty. ECV was associated with greater reward-related VS activation, and the association remained after accounting for family-level markers of disadvantage. We identified an indirect pathway in which socioeconomic disadvantage predicted greater reward-related activation via greater ECV, over and above family-level adversity. These findings highlight the unique impact of community violence exposure on reward processing and provide a mechanism through which socioeconomic disadvantage may shape brain function.

Health-related quality of life over chemotherapy course among individuals with early-stage breast cancer: the association of social determinants of health and neighborhood socioeconomic disadvantage.

This study aimed to examine relationships between health-related quality of life (HRQOL), social determinants of health, and neighborhood socioeconomic disadvantage in individuals with early-stage breast cancer (ESBC) during chemotherapy. This is a longitudinal study that recruited Black and White women with ESBC receiving chemotherapy. Participants completed questionnaires recording their sociodemographic information at baseline and the Functional Assessment of Cancer Therapy-General (FACT-G) to report their HRQOL before each chemotherapy cycle. Linear mixed modeling was employed to examine the associations between FACT-G scores, self-reported race, and area deprivation index (ADI) before and at the last chemotherapy cycle, with the duration of chemotherapy treatment as a covariate. A total of 84 Black and 146 White women with ESBC completed the surveys. Linear mixed modeling results suggested that women with ESBC who reported being Black experienced significantly worse physical well-being than those who reported being White throughout chemotherapy, with a 0.22-point lower average (p = 0.02). Both Black and White women with ESBC experienced decreased functional well-being over the chemotherapy, and Black women consistently reported lower scores than White women, with the change in functional well-being over time differing between racial groups (p = 0.03). Participants' ADI national percentiles were not significantly associated with their HRQOL throughout chemotherapy. These findings underscore possible racial differences in some dimensions of HRQOL during chemotherapy among women with ESBC. Future research should consider further assessing life stressors and past experiences of discrimination and racism that may contribute to these disparities and guide proactive interventions.

Association of Neighborhood Opportunity with Infant Brain Activity and Cognitive Development.

Neighborhood socioeconomic disadvantage is associated with lower neurocognitive scores and differences in brain structure among school-age children. Associations between positive neighborhood characteristics, infant brain activity, and cognitive development are underexplored. We examined direct and indirect associations between neighborhood opportunity, brain activity, and cognitive development. This longitudinal cohort study included infants from 2 primary care clinics in Boston and Los Angeles. Using a sample of 65 infants, we estimated path models to examine associations between neighborhood opportunity (measured by the Child Opportunity Index), infant electroencephalography (EEG) at 6 months, and infant cognitive development (measured using the Mullen Scales of Early Learning) at 12 months. A mediation model tested whether EEG power explained associations between neighborhood opportunity and infant cognition. Neighborhood opportunity positively predicted infant absolute EEG power across multiple frequency bands: low (b = 0.12, 95% CI 0.01-0.24, p = 0.04, = 0.21); high (b = 0.11, 95% CI 0.01-0.21, p = 0.03, = 0.23); (b = 0.10, 95% CI 0.00-0.19, p = 0.04, = 0.20); and (b = 0.12, 95% CI 0.02-0.22, p = 0.02, = 0.24). The results remained statistically significant after applying a Benjamini-Hochberg false discovery rate of 0.10 to adjust for multiple comparisons. No significant associations emerged between neighborhood opportunity, relative EEG power, and infant cognition. Mediation was not significant. Neighborhood opportunity is positively associated with some forms of infant brain activity, suggesting that positive neighborhood characteristics may play a salient role in early development.

Neighborhood Socioeconomic Disadvantage and Distance from Treatment Center Do Not Impact Survival Outcomes of Patients with Non-Hodgkin's Lymphoma (NHL) and Multiple Myeloma (MM) Treated with CAR T-Cell Therapies.

Neighborhood Socioeconomic Disadvantage and Distance from Treatment Center Do Not Impact Survival Outcomes of Patients with Non-Hodgkin's Lymphoma (NHL) and Multiple Myeloma (MM) Treated with CAR T-Cell Therapies.

Neighborhood Socioeconomic Disadvantage and Group B Streptococcus Colonization in Pregnancy

Neighborhood Socioeconomic Disadvantage and Group B Streptococcus Colonization in Pregnancy

Geospatial Disparities in Youth Sexually Transmitted Infections During COVID-19

Introduction: Early in the COVID-19 pandemic, routine sexually transmitted infection (STI) screenings decreased, and test positivity rates increased due to limited screening appointments, national-level STI testing supply shortages, and social distancing mandates. It is unclear if adolescent preventive STI screening has returned to pre-pandemic levels and if pre-existing disparities worsened in late-pandemic. Methods: This cross-sectional study examined 22,974 primary care visits by 13-19-year-olds in the Philadelphia metropolitan area undergoing screening for gonorrhea and chlamydia in a 31-clinic pediatric primary care network during 2018-2022. Using interrupted-time-series analysis and logistic regression, pandemic-related changes in the asymptomatic STI screening rate and test positivity were tracked across patient demographics. Neighborhood moderation was investigated by census-tract-level Child Opportunity Index in 2023. Results: The asymptomatic STI screening rate dropped by 27.8 percentage points (pp) and 13.5pp when the pandemic and national STI test supply shortage began, respectively, but returned to pre-pandemic levels after supply availability was restored in early 2021. Non-Hispanic-Black adolescents had a significant pandemic drop in STI screening rate, and it did not return to pre-pandemic levels (-3.6 pp in the late-pandemic period, p< 0.01). This decrease was more pronounced in socioeconomically and educationally disadvantaged neighborhoods (7.5 pp and 9.9 pp lower, respectively) than in advantaged neighborhoods (both p< .001), controlling for sex, age, insurance type and clinic characteristics. Conclusions: Neighborhood socioeconomic and educational disadvantage amplified racial-ethnic disparities in STI screening during the pandemic. Future interventions should focus on improving primary care utilization of non-Hispanic-Black adolescents to increase routine STI screening and preventive care utilization.

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.

471 Association of neighborhood socioeconomic disadvantage and stillbirth

471 Association of neighborhood socioeconomic disadvantage and stillbirth

Pediatric obesity during COVID-19: the role of neighborhood social vulnerability and collective efficacy.

Childhood obesity increased in the first year of COVID-19 with significant disparities across race, ethnicity, and socioeconomic status. Social distancing led to fewer physical activity opportunities but increased screen time and high-calorie food consumption, all co-determined by neighborhood environments. This study aimed to test the moderation effects of neighborhood socioeconomic and built environments on obesity change during COVID-19. Using electronic health records from a large pediatric primary care network in 2018-2022, we cross-sectionally examined 163,042 well visits of 2-17-year-olds living in Philadelphia County in order to examine (1) the pandemic's effect on obesity prevalence and (2) moderation by census-tract-level neighborhood socioeconomic disadvantage, crime, food and physical activity-related environments using interrupted-time-series analysis, Poisson regression, and logistic regression. Weekly obesity prevalence increased by 4.9 percent points (pp) during the pandemic (January 2021-August 2022) compared to pre-pandemic (March 2018-March 2020) levels. This increase was pronounced across all age groups, racially/ethnically minoritized groups, and insurance types (ranging from 2.0 to 6.4 pp) except the Non-Hispanic-white group. The increase in obesity among children racially/ethnically minoritized groups was significantly larger in the neighborhoods with high social vulnerability (3.3 pp difference between high and low groups), and low collective efficacy (2.0 pp difference between high and low groups) after adjusting for age, sex, and insurance type. Racially/ethnically minoritized children experienced larger obesity increases during the pandemic, especially those in socioeconomically disadvantaged neighborhoods. However, the buffering effect of community collective efficacy on the disparities underscores the importance of environments in pediatric health.

Telemedicine Use among Breast Cancer Patients: Association with Neighborhood Socioeconomic Disadvantage and Comparisons of Oncology Services between Virtual and In-Person Visits (Preprint)

Telemedicine Use among Breast Cancer Patients: Association with Neighborhood Socioeconomic Disadvantage and Comparisons of Oncology Services between Virtual and In-Person Visits (Preprint)

Neighborhood selection by parent personality, depression, and coparent support: A two-study replication.

This study addresses the degree to which three selection factors (parent personality, depression, and coparent support) drive movement into neighborhoods and predict changes in youth externalizing behavior. Two studies followed children from birth to age 15 (N = 1,364 for Study 1; N = 4,898 for Study 2). Neighborhood socioeconomic disadvantage, family income, and youth externalizing behavior were consistently and significantly correlated cross sectionally and longitudinally. Selection factors predicted changes in youth externalizing behavior. Higher family income, mother agreeableness, and perceived support from a coparent predicted movement over time into less disadvantaged neighborhoods. Lower levels of mother impulsivity, neuroticism, and depression also predicted movement over time into less disadvantaged neighborhoods. Neighborhood disadvantage did not predict change in youth externalizing behavior when any of the above selection factors were included in the model. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A study on the sample representativeness of the Wisconsin Alzheimer’s Disease Research Center Clinical Core participants versus the Wisconsin state population

AbstractBackgroundUnderstanding how representative a research sample is compared to the population can help inform future recruitment planning, data analysis strategies, and interpretation of the generalizability of the findings. We compared the demographics, rural residence, neighborhood socioeconomic disadvantage, and vascular risk factors between the Wisconsin Alzheimer’s Disease Research Center (ADRC) Clinical Core participants versus the Wisconsin state adult population.MethodThe ADRC participant sample (n = 678) included all active participants as of November 30, 2021. The state population statistics were estimated using multiple national and state data sources. Differences between the sample versus the population were tested using the one‐sample z‐test, the one‐sample Wilcoxon signed rank test, the exact binomial test, and the exact Monte Carlo multinomial test. Except for age, comparisons were performed for two age groups: 45‐64 years and ≥ 65 years, separately.ResultThe ADRC participants are older than the state population. For each age group, compared to the state population, the ADRC participants include more women and greater proportions of Black and American Indians, have higher levels of educational attainment, have smaller percentages living in rural areas and more disadvantaged neighborhoods, and show lower vascular risks. The sample versus population differences are greater for the ≥ 65 years group (the group at higher risk for AD) than the 45‐64 years group for most metrics, however, are smaller for sex and neighborhood disadvantage.ConclusionThe ADRC targets recruiting middle‐aged and older adults with dementia, mild cognitive impairment, or increased risk for AD. Thus, the participants are not a suitable sample for epidemiology studies on AD prevalence. Oversampling underrepresented racial groups would alleviate the lack of statistical power associated with small or unbalanced sample sizes and increase the precision in effect size estimates for studies on racial disparities. Future recruitment should endeavor to include participants from a broader range of educational backgrounds and more residents in rural areas and disadvantaged neighborhoods. These subpopulations have inequitable access to quality health care and are at greater risk. Properly representing them in research would allow conclusions to be generalizable to these subpopulations and support policy making to meet their needs.

Abstract B082: Interrogating the mechanistic link between neighborhood disadvantage colorectal cancer risk through DNA methylation analysis of African American colorectum

Abstract Environmental and social factors account for approximately 65% of colorectal cancer (CRC) risk. Identifying mechanisms associated with CRC risk may provide crucial insight for future drug targeting, as well as prevention and screening strategies. The Neighborhood Disadvantage Index (NDI) is a composite score of 17 social and environmental measures that has been shown to be associated with poorer health outcomes independently of an individual’s own socioeconomic status. While African Americans (AAs) are more likely to live in areas of high NDI, both non-Hispanic Whites and AAs living in areas of high NDI experience increased stress and poorer health. Recently, increased NDI scores have also been positively associated with CRC risk. The mechanisms through which these social factors influence disease risk are yet to be elucidated. DNA methylation represents one epigenetic marker that exists at the interplay between environment and disease risk. Here, we hypothesize that an analysis of NDI in an at-risk population for CRC will reveal DNA methylation differences relevant to disease. We performed genome-wide DNA methylation analysis of triple-matched, normal right and left colon, and rectal biopsies of 72 African Americans using the Illumina Infinium MethylationEPIC kit. After preprocessing of individual probes and samples, we generated a mixed-effects model to define differentially methylated regions (DMRs) that were consistently associated with NDI across all colorectal locations using DMRcate. The duplicateCorrelation function of Limma was used to account for repeated measures through addition of a random intercept. We identified 810 differentially methylated regions (DMRs) associated with NDI. Through gene-set enrichment analysis, we found that these DMRs were associated with CRC risk processes such as cell morphogenesis (FDR= 7.33E-05), development (FDR=1.18E-04) and growth (FDR=1.17E-02). Secondary analysis of five publicly available datasets revealed a subset of 17 that overlapped DMRs identified in all CRC tumor versus normal adjacent tissue analyses. To map DMRs to likely gene expression targets, further analysis was carried out in two, publicly available CRC tumor datasets. Our analysis found that of the 17 targets, eight were differentially expressed in TCGA-COAD with four of these also being differentially expressed in TCGA-READ. This included CAP-Gly domain containing linker protein family member 4 (CLIP4), which was reduced in TCGA-COAD (FDR=1.29E-28) and TCGA-READ (FDR=8.52E-08). DNA hypermethylation of chr2:29337946-29338121, which corresponded to CLIP4, was associated with increasing NDI in our analysis (FDR=0.040). Our study provides the first empirical evidence supporting DNA methylation as a plausible mechanism through which neighborhood socioeconomic disadvantage impacts colon carcinogenesis and drives disproportionately high risk of CRC among African Americans. Specifically, our findings indicate that epigenetic dysregulation of CLIP4 represents one potential marker of NDI-related disease risk. Citation Format: Matthew Devall, Xiangqing Sun, Stephen Eaton, Cynthia Yoshida, Samyukta Venkatesh, Gregory Cooper, Joseph Willis, Daniel Weisenberger, Graham Casey, Li Li. Interrogating the mechanistic link between neighborhood disadvantage colorectal cancer risk through DNA methylation analysis of African American colorectum [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 B082.

Association of Neighborhood Socioeconomic Disadvantage with Utilization of Minimally Invasive Resection for Non-Small Cell Lung Cancer

Minimally invasive resection for non-small cell lung cancer has been linked to decreased postoperative morbidity. This work sought to characterize factors associated with receiving minimally invasive surgery for surgically resectable non-small cell lung cancer. All adults undergoing lobectomy/sublobar resection for stage I non-small cell lung cancer were identified using the 2010-2020 National Cancer Database. Those undergoing thoracoscopic/robotic procedures comprised the minimally invasive resection cohort (others: open). Hospitals were stratified by minimally invasive resection procedure volume, with the top quartile considered high minimally invasive resection volume centers. Multivariable models were constructed to assess the independent association between the patients, diseases, and hospital factors and the likelihood of receiving minimally invasive resection. Of 217,762 patients, 112,304 (52%) underwent minimally invasive resection. The proportion of minimally invasive resection procedures increased from 27% in 2010 to 72% in 2020 (P<.001). After adjustment, several factors were independently associated with decreased odds of receiving minimally invasive resection, including lower quartiles of median neighborhood income (51st-75th percentile adjusted odds ratio, 0.92, 95% CI, 0.89-0.94; 26th-50th percentile adjusted odds ratio, 0.86, CI, 0.83-0.89; 0-25th percentile adjusted odds ratio, 0.78, CI, 0.75-0.81; reference: 76th-100th percentile income) and care at community hospitals (adjusted odds ratio, 0.70, CI, 0.68-0.71; reference: academic centers). Among patients receiving care at high minimally invasive resection volume centers, lowest income remained linked with reduced likelihood of undergoing minimally invasive resection from 2010 to 2015 (adjusted odds ratio, 0.85, CI, 0.77-0.94), but did not alter the odds of minimally invasive resection in later years (adjusted odds ratio, 1.01, CI, 0.87-1.16; reference: highest income). This study identified significant community income-based disparities in the likelihood of undergoing minimally invasive resection as definitive surgical treatment. Novel interventions are warranted to expand access to high-volume minimally invasive resection centers and ensure equitable access to minimally invasive surgery.

Neighborhood Socioeconomic Disadvantage and Distance from Treatment Center Do Not Impact Survival Outcomes of Patients with Non-Hodgkin Lymphoma and Multiple Myeloma Treated with CAR T-Cell Therapies

Introduction: Chimeric antigen receptor (CAR) T-cell therapies have radically changed the treatment paradigm of patients (pts.) with relapsed/refractory (r/r) hematologic malignancies. Despite their remarkable efficacy, health care disparities can impact outcomes of pts. in the real-world setting. Living in a disadvantaged neighborhood has been associated with inferior outcomes after allogenic hematopoietic stem cell transplantation (HSCT), independent from individual-level socioeconomic (SE) factors. Our study aimed to identify the impact of neighborhood adversity on survival outcomes of recipients of CAR T-cell therapies, as this has not been yet described. Methods: We retrospectively identified consecutive adult pts. with r/r B-cell non-Hodgkin lymphoma (B-NHL) and multiple myeloma (MM) who received CAR T-cell therapies at our center from May 2018- January 2023. Neighborhood disadvantage was defined by Area Deprivation Index (ADI), a validated tool that allows for ranking of census block groups based on SE domains (income, education, employment, and housing quality) at a national level. The 2021 national ADI percentile ranks (1-100) were obtained for each pt. using the 9-digit zip code of place of residence, with a higher rank corresponding to higher level of disadvantage. We compared overall survival (OS) and progression free survival (PFS) between pts. with high vs. low ADI. We also examined survival outcomes in relation to estimated distance from place of residence to treatment center (DTC). Time dependent outcomes were calculated from date of CAR T infusion. Pts. with B-NHL and MM were analyzed separately. Baseline variables were compared between groups using chi-squared, t-test, and Wilcoxon rank sum tests as appropriate. Survival estimates were calculated with Kaplan-Meier method, and hazard ratios were generated using cox proportional hazards model. Results: CAR T therapy was administered in 124 and 45 pts. with B-NHL and MM, respectively. Median ages were 65 and 62 yrs., 68% and 51% were male, 94% and 84% were White, 47% and 20% had high-risk disease (based on IPI/MIPI for B-NHL, and FISH for MM), 30% and 69% had prior HSCT, and median number of prior therapies were 3 (range 1-6) and 6 (range 4-14), among pts. with B-NHL and MM, respectively. B-NHL subtypes included DLBCL (84%), MCL (6%), FL (5%), and PMBCL (5%), and CAR T products for B-NHL were axi-cel (52%), tisa-cel (24%), liso-cel (18%) and brexu-cel (6%). Ide-cel (82%) and cilta-cel (18%) were used in pts. with MM. We treated pts. from 169 census block groups over 8 states, although 89% pts. were from Ohio. For the entire cohort, median ADI rank was 62.5 (range 1-100) and median DTC was 42.5 (range 1-4559) miles (m). Pts. were categorized (based on median) as having high (&amp;gt; 62.5) or low (≤ 62.5) ADI, and long (&amp;gt; 42.5m) or short (≤ 42.5m) DTC. Longer DTC was significantly associated with higher ADI ( p&amp;lt;0.001). Baseline characteristics (age, sex, prior therapies, prior HSCT, high risk disease, CAR T product) were similar across groups with low vs. high ADI and short vs. long DTC. Median follow up time up was 12 (range 4-60) and 9 (range 4-22) months for living pts. with B-NHL and MM, respectively. For pts. with B-NHL, objective response rates (ORR) (85% vs. 80%; p=0.4), relapse rates (RR) (66% vs. 66%; p=0.9), median OS (19 vs. 14 months; HR of death: 1.2; 95% CI 0.7-1.8; p=0.5) ( Fig.1), and median PFS (10 vs. 5 months, HR of relapse: 1.1, 95% CI 0.7-1.7; p=0.6) were similar for pts. with low vs. high ADI. For pts. with MM, there were no differences in ORR (77% vs. 87%; p=0.3), RR (77% vs. 70%; p=0.5), median OS (14 vs. 18 months; HR of death: 0.8; 95% CI: 0.3-2; p=0.6) ( Fig.2), and median PFS (7 vs. 9 months, HR of relapse: 0.7, 95% CI 0.3-1.4; p=0.3) between those with low vs. high ADI. There were no differences in median OS of pts. with short vs. long DTC for NHL (19 vs. 14 months; HR: 1.2, 95% CI 0.7-1.9, p=0.4) or MM (14 vs. 20 months; HR: 0.9, 95% CI 0.3-2.5; p=0.9), or when DTC was analyzed as a continuous variable. Conclusion: In patients with r/r B-NHL and MM who received CAR T-cell therapies, response rates and survival outcomes were comparable regardless of neighborhood disadvantage level or distance to treatment center. Pts. living in more disadvantaged neighborhoods travelled longer distances for treatment. These findings prompt future investigation into referral patterns and access barriers to cellular immunotherapy, especially in disadvantaged neighborhoods.

Impact of Neighborhood Opportunity on Missed Clinic Visits and Acute Care Utilization in Individuals with Sickle Cell Disease

Background: Sickle cell disease (SCD) is a complex inherited blood disorder associated with high acute healthcare utilization, further complicated by psychosocial and socioeconomic factors. Social determinants of health (SDOH) have a known impact on healthcare access and health outcomes, particularly in minoritized communities. The Area Deprivation Index (ADI) is a composite measure of neighborhood socioeconomic disadvantage. The Childhood Opportunity Index (COI) is a validated approach for estimating multi-dimensional SDOH leading to inequitable distribution of opportunity across neighborhoods. Both have been associated with acute care utilization in pediatric populations other than SCD. We hypothesize that ADI and COI will be associated with acute care utilization and care access in SCD, as well. Methods: Data were collected retrospectively from the electronic medical record between September 2021 and July 2023 for patients followed at a Midwestern Pediatric SCD Clinic who completed a Psychosocial Assessment Tool (PAT) at an annual comprehensive visit. The PAT is a validated quantitative caregiver survey used to screen for psychosocial risk factors and resiliency, with subcategories such as social support, child problems, structure/resources, and family beliefs. Number of emergency department (ED) visits, hospitalizations, and missed clinic visits were collected from the time the PAT was completed up to 1 year after (or the end of the data collection period). The area deprivation index (ADI) and childhood opportunity index (COI) were determined utilizing census block data for the patient at the time the PAT was completed. Descriptive statistics were performed on all data above, as well as t-tests and chi square tests for univariate analyses. Results: One hundred seventy-four unique patients completed a PAT during the study period. The median age of the child with SCD was 11.5 years (range 4-22 years), with the majority having Hb SS disease (61%). Eighty-nine percent had a primary care provider documented and 75% had public insurance. The median state ADI (6) and COI (2) for the cohort demonstrated significant neighborhood disadvantage/SDOH for all patients (See Figure). Ninety-two unique patients had 239 ED encounters. Fifty-eight unique patients accounted for 149 hospitalizations. Forty-seven percent of those hospitalized had a PAT in the Targeted or Clinical range (i.e. increased psychosocial stressors) compared to 30% of those who had not been hospitalized ( p=0.04). There was no statistically significant difference between ADI or COI and number of ED encounters or hospitalizations. However, patients who missed 1 or more SCD visits (n=79) had a higher median state ADI than those who did not miss a visit (8 vs 6, p=0.009). Median state COI was also lower in this group than those who did not miss a visit (1 vs 2, p=0.008). Forty-eight percent of those who missed 1 or more SCD visit had a PAT in the Targeted or Clinical category versus 27% of those who did not miss any ( p=0.009). Conclusion: While those with significant SDOH and neighborhood disadvantage did not have higher rates of acute care utilization in this cohort, there was a significant contribution to missed preventative SCD care visits, further emphasizing the need for psychosocial support and resources as essential elements to SCD programs, as well as alternative forms of care delivery, such as telemedicine, to improve access to SCD specialists. Further studies are needed to understand the impact comprehensive resources such as these may have on care burden, as well as disease outcomes.

Enhanced Support Services Including Nurse Navigation Mitigate Socioeconomic Disparities in the Treatment of Patients with Acute Lymphoblastic Leukemia

Background: Despite recent advances in therapy (especially in the pediatric population), the treatment of acute lymphoblastic leukemia (ALL) in adult patients remains extremely challenging with only an estimated 30-40% of patients achieving long-term remission. Therefore, it is imperative to identify barriers that may impact delivery of therapy and lead to disparities of outcomes. One area of concern that has been consistently identified is the impact of socioeconomic disparities on the delivery of care. The primary objective of this study is to determine whether increased neighborhood socioeconomic disadvantage as measured by the Area Deprivation Index (ADI) impacts overall survival (OS) in patients with ALL. Methods: All patients who presented to the Levine Cancer Institute, a tertiary hospital-based specialty practice, from January 1, 2016 to December 31, 2022 were eligible for inclusion. Patients were included for final analysis if they were aged ≥ 18 years, and had a verified new diagnosis of ALL. All patients received supportive care per institutional standards including nurse navigation, social work, and financial counseling with referral to Financial Toxicity Tumor Board if indicated. Patient demographic, treatment, and disease characteristics were summarized with frequencies (and percentages) or medians (and ranges). Correlation between national and state ADIs were assessed with Spearman's rank correlation coefficient. National and state ADI were analyzed as continuous ranks and as quartile (median for both national and state ADI; quartiles for national ADI). Kaplan-Meier methods were used to summarize OS and estimate landmark survival rates. Cox proportional-hazards models estimated hazard ratios and 95% confidence intervals associated with ADI. Multivariable models with adjustments for clinical covariates included age at diagnosis, risk group, and treatment received (including Oncology Nurse Navigation [ONN] services). Results: A total of 100 patients were found to meet criteria for inclusion. Specific characteristics of the analyzed population are listed in Table 1. The population had a median age of 54 years and were primarily treated per three treatment paradigms (standard adult intensive (57%), pediatric-based (14%), and reduced-intensity (28%)). Overall median follow-up (95% CI) was 52.2 months (44.1, 55.5) with a median OS of 51.4 months (25.3 to non-estimable) and median relapse free survival (RFS) of 22.8 months (17.0 to 35.7). When dichotomized by median ADI, there was no significant difference in patient characteristics in the two groups including age, gender, race/ethnicity, ALL type, insurance type, induction regimen, and receipt of ONN services. In univariate modeling, ADI as a continuous variable was not found to be associated with OS (HR 1.01; 95% CI 0.99-1.02, P=0.321) or RFS (HR 1.01; 95% CI 0.99-1.02, P=0.288). This lack of association remained true when dichotomized by median ADI into high and low ADI areas (OS HR 1.01; 95% CI 0.58-1.79, P=0.966; RFS HR 1.17; 95% CI 0.70-1.94, P=0.552), as well as by splitting ADI into quartiles (Figure 1). A multivariate model including age at diagnosis, ALL type, ONN services received, and treatment regimen similarly showed no association between ADI and OS (p=0.221) and RFS (p=0.453). Of particular interest is the high extent of navigation services received in this population (62.8% of patients in areas of less disadvantage, and 73.5% of patients from areas of higher disadvantage). Patients who received navigation services also appeared to be a higher risk population, as multi-variable modeling confirmed both decreased OS (HR 2.11; 95% CI 1.12-4.00, P=0.023) and RFS (HR 2.08; 95% CI 1.17-3.71, P=0.012) when compared to those who were not deemed by the nurse navigators to need this service. Conclusions: Contrary to larger database derived studies, patients with ALL treated at our center did not show differences in OS or RFS when compared by neighborhood disadvantage. This is likely a consequence of the strong support systems available at this institution in nurse navigation and financial toxicity related programs which help mitigate some of the risk factors for disparate outcomes. These findings should be validated in a larger cohort with prospective data with a particular focus on designing sustainable and realistic options to be utilized at community-based and underserved systems.

1853. Examining the Role of Race-Ethnicity and Neighborhood Socioeconomic Disadvantage in Influenza Vaccine Uptake

Abstract Background Negative influenza-associated outcomes disproportionately impact non-White individuals. Targeted influenza vaccine coverage could improve outcomes in minority groups. This study examined the role of race-ethnicity and resource inequity in vaccine coverage. Methods We analyzed data from all outpatient visits at University Hospitals CMC from October 01, 2022 to February 28, 2023. Race, ethnicity, age, sex, income, home address, ICD diagnosis, and influenza immunization records were collected. Patients who received an influenza vaccine between July 01, 2022 and February 28, 2023 were considered immunized. A 9-digit patient zip code was used to obtain state Area Depravity Index (ADI) data provided by University of Wisconsin School of Medicine and Public Health. The state ADI ranges from 1 to 10, with group 1 being the least disadvantaged and 10 being the most disadvantaged. We used logistic regression analysis to estimate the odds for being vaccinated predicted by race-ethnicity, state ADI, age, and sex. Results Out of 301,572 hospitalizations, 59.0% were women, 81.2% were White non-Hispanic, 16.0% were Black non-Hispanic, and 2.7% were Hispanic. Black non-Hispanics were most disadvantaged with a mean State ADI of 7.54, followed by Hispanics at 5.64. White non-Hispanics were least disadvantaged with a mean State ADI of 3.99 (p&amp;lt; 0.001)(Table 1). Black non-Hispanics were disproportionately represented in the most disadvantaged areas (27.93%). Black non-Hispanics were 38% less likely to be vaccinated than White non-Hispanics. After ADI, sex, and age adjustment, Black non-Hispanics were 11% less likely to be vaccinated (OR: 0.89; 95% CI: 0.868 - 0.912). With each point increase in State ADI, vaccination rate decreased by 7% (OR: 0.93; 95% CI: 0.928 – 0.933)(Table 3). Regression analysis suggested significant interaction between race-ethnicity and State ADI. Influenza Vaccination by individual characteristics within overall population and race-ethnicity Influenza vaccination by race-ethnicity adjusting for State ADI, age, and sex Influenza vaccination by race-ethnicity adjusting for State ADI and sex, and stratified by age groups Conclusion This cross-sectional study found racial and ethnic disparities in rates of influenza vaccination. The effect of race-ethnicity on vaccination rate is dependent on ADI. These data identified subgroups on which to focus future influenza prevention efforts. The generalization of the study is limited and similar analysis from other areas and vaccines would be beneficial. Disclosures Elie Saade, MD, MPH, FIDSA, Envision Pharma: Speaker, Presenter|Johnson and Johnson: Speaker, Travel, Lodging|Protein Sciences Corp: Grant/Research Support|Sanofi Pasteur: Speaker, Travel and Lodging