Assessment of Regional Variability in COVID-19 Outcomes Among Patients With Cancer in the United States

Abstract

IMPORTANCEThe COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography. OBJECTIVETo quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer. DESIGN, SETTING, AND PARTICIPANTS This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States. EXPOSURES Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of centerlevel and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time. RESULTS Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers.Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted (continued)

Breakthrough SARS-CoV-2 infections among patients with cancer following two and three doses of COVID-19 mRNA vaccines: a retrospective observational study from the COVID-19 and Cancer Consortium

“…There may be residual confounding due to regional and center-level factors which are incompletely captured in the CCC19 data model. 30 Additionally, the exact timing of breakthrough infections in relation to COVID-19 vaccination were not precisely determined, as our current analysis relied on time intervals instead. Despite such limitations, this represents one of the largest cohorts with comprehensive clinical and biological data on vaccinated patients with cancer and breakthrough COVID-19 reported to date.…”

The social vulnerability index as a risk stratification tool for health disparity research in cancer patients: a scoping review

“…A summary of the 31 included studies is presented in Table 1, and their primary and secondary outcomes are shown in Supplementary Table S2. Of the 31 included studies, 28 (90.3%) executed a cross-sectional study design based on secondary data analyses [26-30, 32-41, 43-45, 47-56], and 3 (9.7%) studies executed a retrospective cohort study design with longitudinal follow-up of patient outcomes [31,42,46].…”

“…Specific datasets included the Medicare Single Analytic Files [26,27,34,37,38,43,44,53], Medicare Provider Analysis and Review [36,56], SEER-21 [32], and the SEER-Medicare linked database [28,29,52]. Other specific national data sources included the National Center for Health Statistics [50], the CDC Wide-ranging ONline Data for Epidemiologic Research database [39], the COVID-19 and Cancer Consortium Database [42]. In addition, one study utilized data obtained from a national clinical trials database (ClinicalTrials.gov) [41].…”

COVID-19 and Cancer: Special Considerations for Patients Receiving Immunotherapy and Immunosuppressive Cancer Therapies

“…7 Overall, mortality risk has decreased over time. 8,9 Risk factors for poor COVID-19 outcomes in patients with cancer have emerged, including male sex, being older than age 65, smoking status, a higher number of medical comorbidities, high Eastern Cooperative Oncology Group performance status, and the presence of hematologic malignancies or lung cancer, that are associated with disease severity, hospitalization, intensive care unit admission, and mortality.…”