Area Deprivation Index and Rurality in Relation to Lung Cancer Prevalence and Mortality in a Rural State

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>We sought to describe lung cancer prevalence and mortality in relation to socioeconomic deprivation and rurality.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>We conducted a population-based cross-sectional analysis of prevalent lung cancers from a statewide all-payer claims dataset from 2012 to 2016, lung cancer deaths in Maine from the state death registry from 2012 to 2016, rurality, and area deprivation index (ADI), a geographic area-based measure of socioeconomic deprivation. Analyses examined rate ratios for lung cancer prevalence and mortality according to rurality (small and isolated rural, large rural, or urban) and ADI (quintiles, with highest reflecting the most deprivation) and after adjusting for age, sex, and area-level smoking rates as determined by the Behavioral Risk Factor Surveillance System.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Among 1 223 006 adults aged 20 years and older during the 5-year observation period, 8297 received lung cancer care, and 4616 died. Lung cancer prevalence and mortality were positively associated with increasing rurality, but these associations did not persist after adjusting for age, sex, and smoking rates. Lung cancer prevalence and mortality were positively associated with increasing ADI in models adjusted for age, sex, and smoking rates (prevalence rate ratio for ADI quintile 5 compared with quintile 1 = 1.41, 95% confidence interval [CI] =1.30 to 1.54) and mortality rate ratio = 1.59, 95% CI = 1.41 to 1.79).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Socioeconomic deprivation, but not rurality, was associated with higher lung cancer prevalence and mortality. Interventions should target populations with socioeconomic deprivation, rather than rurality per se, and aim to reduce lung cancer risk via tobacco treatment and control interventions and to improve patient access to lung cancer prevention, screening, and treatment services.</jats:p> </jats:sec>

Neighborhood and Individual Socioeconomic Disadvantage and Survival Among Patients With Nonmetastatic Common Cancers

“…This study is among the first to our knowledge to use national data, as most prior studies investigated the link between ADI and cancer using primarily regional databases. Neighborhood disadvantage has been reported to be associated with (1) increased cancer prevalence, incidence, and mortality 8 , 46 ; (2) obesity and inferior overall survival among pediatric patients with acute lymphoblastic leukemia 61 , 62 ; (3) lack of adjuvant therapy among patients with localized pancreatic cancer 63 ; and (4) anxiety among patients with advanced cancer. 64 One SEER study 8 reported higher ADI (neighborhood disadvantage) to be associated with worse overall survival among cancer patients diagnosed between 1988 and 1999: HRs (highest decile vs lowest decile) were 1.68 (95% CI, 1.57-1.79) for breast, 1.57 (95% CI, 1.46-1.68) for prostate, 1.29 (95% CI, 1.23-1.36) for colorectal, and 1.56 (95% CI, 1.54-1.59) for all cancers.…”

“…44 The ADI ranges from 1 to 100 and is presented in national percentile rankings, with higher scores indicating higher levels of neighborhood socioeconomic disadvantage. In line with previous studies, 33 , 45 , 46 , 47 , 48 we categorized the ADI measure into quintiles within each cohort. Quintile 1 corresponded to the most affluent neighborhoods, whereas quintile 5 referred to the most deprived neighborhoods.…”

Analysis of Delayed Surgical Treatment and Oncologic Outcomes in Clinical Stage I Non–Small Cell Lung Cancer

“…The ADI variable is a geography-based measure of socioeconomic deprivation based on 17 US Census poverty, education, housing, and employment indicators that has previously been associated with worse lung cancer outcomes. 17 , 18 Comorbidity burden was measured using the Charlson-Deyo Comorbidity Index (CCI) based on ICD-9 and ICD-10 codes within 5 years of the date of surgical treatment. 19 , 20 We also abstracted operation-specific and tumor-specific characteristics, including tumor size, tumor histology, tumor grade, hospital volume (measured as number of patients with a lung cancer diagnosis at that institution in the year prior to the patient’s surgical procedure), year of operation, performance of invasive mediastinal staging (ie, endobronchial ultrasound or mediastinoscopy), incision type (ie, video-assisted thoracoscopic surgical procedure or thoracotomy), operation type (ie, lobectomy, segmentectomy, wedge resection, or pneumonectomy), and number of lymph nodes examined.…”

The role of neighborhood disadvantage in predicting mortality in patients after transcatheter aortic valve replacement

“…Area-based measures of socioeconomic status have been shown to predict poor outcomes in a variety of disease states, including heart disease. 6,[13][14][15][16]21 From the surgical literature, the incorporation of neighborhood-level socioeconomic factors into risk prediction models has been shown to have the potential to add prognostic value in the prediction of outcomes after cardiac surgery. 6,21 Taylor et al described in their 2003 study how higher area deprivation scores were associated with increased length of hospital stay, postoperative MI, and increased combined postoperative MI, stroke, and death in patients undergoing CABG in England.…”

“…The area deprivation index (ADI) is an easy to use and freely available metric for simultaneously evaluating multiple social determinants of health based on the neighborhood in which a patient resides 12 . Neighborhood disadvantage, as assessed by the ADI, has been associated with increased hospital readmissions, 13 higher prevalence of obesity, 14 an increased prevalence and mortality from lung cancer, 15 and increased odds of Alzheimer disease neuropathology 16 . Neighborhood disadvantage has never before been evaluated as a marker of poor outcomes in patients after TAVR.…”