Neighborhood and individual socioeconomic disadvantage is associated with worse overall and cancer-specific survival among patients with nonmetastatic prostate, breast, lung, and colorectal cancer, according to study findings published online in JAMA Network Open.
“Our findings may support policies for ongoing investments in disadvantaged neighborhoods and low-income households, which could increase their opportunities for healthy and safe living and expand their access to timely cancer treatment,” En Cheng, MD, PhD, of the Yale School of Public Health in New Haven, Connecticut, and colleagues wrote.
The investigators based their findings on an analysis of data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database (January 1, 2008 through December 31, 2011), with follow-up ending on December 31, 2017. Participants included patients aged 65 years or older. The primary and secondary outcome was overall and cancer-specific mortality, respectively. The investigators measured neighborhood socioeconomic status (SES) using the area deprivation index (ADI), a validated comprehensive measure of neighborhood SES. They placed patients into ADI quintiles.
The study cohort included 96,978 patients: 35,150 with prostate cancer, 25,968 with breast cancer, 16,684 with lung cancer, and 19,176 with colorectal cancer. The median ages of patients when they were diagnosed with these cancers were 73, 76, 76, and 78 years, respectively.
Patients with prostate, breast, lung, and colorectal cancer who lived in the most disadvantaged neighborhoods (ADI quintile 5) had a significant 51%, 34%, 21%, and 24% higher risk for overall mortality, respectively, and 38%, 50%, 16%, and 33% higher risk for cancer-specific mortality, respectively, compared with their counterparts living in the most affluent neighborhoods (ADI quintile 1), Dr Cheng and colleagues reported.
The investigators also assessed individual SES using Medicare-Medicaid dual eligibility (yes vs no) and its effect on mortality outcomes. Dual eligibility, an indicator of individual socioeconomic disadvantage, among patients with prostate, breast, lung, and colorectal cancer was significantly associated with a 29%, 22%, 14%, and 23% increased risk for overall mortality, respectively, and 29%, 23%, 14%, and 29% increased risk for cancer-specific mortality, respectively.
Cheng E, Soulos PR, Irwin ML, et al. Neighborhood and individual socioeconomic disadvantage and survival among patients with nonmetastatic common cancers. JAMA Netw Open. Published online December 17, 2021. doi:10.1001/jamanetworkopen.2021.39593.