HSR22-184: The Association of the Social Vulnerability Index to Timely Treatment of Metastatic Cancers Among Insured Adult Patients in the US

Zyczynski, Teresa; Tabak, Ying P.; Sun, Xiaowu; Coetzer, Henriette; Zhang, Ying; Smith, Cardinale B.

doi:10.6004/jnccn.2021.7232

Cited by 2 publications

(5 citation statements)

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“…One study of patients with metastatic cancer that used medical and pharmacy claims data showed that individuals from areas with increased vulnerability (SVI) were up to 30% less likely to be treated within 30 days after a metastatic cancer diagnosis. 15 Our study used a horizon of 1 year and may not have detected disparities in delayed initiation of care.…”

Section: Discussionmentioning

confidence: 99%

“…These measures incorporate both the social and the built environment of the community and include socioeconomic status, educational level, housing quality, transportation, health infrastructure, language barriers, and medical vulnerability at the area level. Prior research demonstrates that these area-level measures are independently associated with cancer incidence, screening, treatment, and outcomes in both localized and metastatic cancers, showing that the community within which patients live can have consequences for their health …”

Section: Introductionmentioning

confidence: 99%

“…Prior research demonstrates that these area-level measures are independently associated with cancer incidence, screening, treatment, and outcomes in both localized and metastatic cancers, showing that the community within which patients live can have consequences for their health. [14][15][16] Prior literature has demonstrated a compounding negative association between social vulnerability and individual-level measures and disparities in survival for common, largely treatable cancers. [17][18][19] The investigation of possible mediating effects of area-level metrics may therefore help explain treatment and potentially survival differences.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…In this study, we examined available social indices of social determinants of health, including SVIs, SDIs, and ICE measures; examined their association with disparities in mRCC treatment after adjusting for patient-level factors; and further incorporated patient-level SES metrics in the form of LIS eligibility. 15 Our objectives were to assess whether area-level measures of disadvantage were independently associated with adoption of emerging therapies and to understand how they interact with race and ethnicity to impact receipt of treatment.…”

Section: Introductionmentioning

confidence: 99%

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Area Vulnerability and Disparities in Therapy for Patients With Metastatic Renal Cell Carcinoma

Rahman,

Long,

Westvold

et al. 2024

JAMA Netw Open

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ImportanceArea-level measures of sociodemographic disadvantage may be associated with racial and ethnic disparities with respect to receipt of treatment for metastatic renal cell carcinoma (mRCC) but have not been investigated previously, to our knowledge.ObjectiveTo assess the association between area-level measures of social vulnerability and racial and ethnic disparities in the treatment of US Medicare beneficiaries with mRCC from 2015 through 2019.Design, Setting, and ParticipantsThis retrospective cohort study included Medicare beneficiaries older than 65 years who were diagnosed with mRCC from January 2015 through December 2019 and were enrolled in fee-for-service Medicare Parts A, B, and D from 1 year before through 1 year after presumed diagnosis or until death. Data were analyzed from November 22, 2022, through January 26, 2024.ExposuresFive different county-level measures of disadvantage and 4 zip code–level measures of vulnerability or deprivation and segregation were used to dichotomize whether an individual resided in the most vulnerable quartile according to each metric. Patient-level factors included age, race and ethnicity, sex, diagnosis year, comorbidities, frailty, Medicare and Medicaid dual enrollment eligibility, and Medicare Part D low-income subsidy (LIS).Main Outcomes and MeasuresThe main outcomes were receipt and type of systemic therapy (oral anticancer agent or immunotherapy from 2 months before to 1 year after diagnosis of mRCC) as a function of patient and area-level characteristics. Multivariable regression analyses were used to adjust for patient factors, and odds ratios (ORs) from logistic regression and relative risk ratios (RRRs) from multinomial logistic regression are reported.ResultsThe sample included 15 407 patients (mean [SD] age, 75.6 [6.8] years), of whom 9360 (60.8%) were men; 6931 (45.0%), older than 75 years; 93 (0.6%), American Indian or Alaska Native; 257 (1.7%), Asian or Pacific Islander; 757 (4.9%), Hispanic; 1017 (6.6%), non-Hispanic Black; 12 966 (84.2%), non-Hispanic White; 121 (0.8%), other; and 196 (1.3%), unknown. Overall, 8317 patients (54.0%) received some type of systemic therapy. After adjusting for individual factors, no county or zip code–level measures of social vulnerability, deprivation, or segregation were associated with disparities in treatment. In contrast, patient-level factors, including female sex (OR, 0.78; 95% CI, 0.73-0.84) and LIS (OR, 0.48; 95% CI, 0.36-0.65), were associated with lack of treatment, with particularly limited access to immunotherapy for patients with LIS (RRR, 0.25; 95% CI, 0.14-0.43). Associations between individual-level factors and treatment in multivariable analysis were not mediated by the addition of area-level metrics. Disparities by race and ethnicity were consistently and only observed within the most vulnerable areas, as indicated by the top quartile of each vulnerability deprivation index.Conclusions and RelevanceIn this cohort study of older Medicare patients diagnosed with mRCC, individual-level demographics, including race and ethnicity, sex, and income, were associated with receipt of systemic therapy, whereas area-level measures were not. However, individual-level racial and ethnic disparities were largely limited to socially vulnerable areas, suggesting that efforts to improve racial and ethnic disparities may be most effective when targeted to socially vulnerable areas.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%