Association of socioeconomic deprivation with clinical outcomes among hospitalized patients with cancer.

Abstract

e23107 Background: Individuals with cancer often require hospitalization to address acute concerns. Structural barriers, such as socioeconomic deprivation, may impact patients’ healthcare utilization. However, little is known about associations of socioeconomic deprivation with clinical outcomes among hospitalized patients with cancer. Methods: We conducted a retrospective cohort study of adults with cancer who were admitted to the University of Oklahoma Medical Center from 1/2017-12/2022. We extracted information from the electronic health record about patients’ socioeconomic deprivation (measured as area deprivation index [ADI]), as well as demographic and clinical characteristics. We categorized ADI into quartile groups (Q1-Q4, with Q4 indicating areas of highest deprivation). We used regression models to explore associations of ADI with patients’ demographic/clinical characteristics and their clinical outcomes (hospital length of stay [hazard ratio {HR} for time to discharge], time to readmission, and overall survival). Results: Among 20,683 patients (mean age 62.2, 51.5% female sex, 41.0% metastatic disease), the most common cancer types were gastrointestinal (GI; 19.3%), genitourinary (13.8%), and gynecologic (13.7%). Races represented were White (80.1%), Black (9.8%), American Indian/Alaska Native (4.8%), Asian (2.6%), and other (2.7%). Mean ADI score was 56.9 ± 26.0, with 17.7% of patients in Q1, 17.6% in Q2, 36.5% in Q3, and 28.2% in Q4. Factors significantly associated with ADI included older age (Beta [B]=-.10, p<.001), race (American Indian/Alaska Native patients [B=11.5, p<.001] and Black patients [B=13.0, p<.001]), comorbid conditions (CCI 1-2 [B:1.47, p=.003]; CCI 3+ [B:2.41, p<.001]), and cancer type (GI: ref; CNS [B=-2.68, p<.001], melanoma [B=-3.85, p=.004], sarcoma [B=-4.19, p=.002]). In multivariable models adjusted for demographic variables significantly associated with ADI, higher ADI was associated with longer length of stay (Q1: ref, Q2: HR=.96, p=.067; Q3: HR .89, p<.001; Q4: HR=.88, p<.001), lower risk for readmission (Q1: ref, Q2: HR=.89, p=.002; Q3: HR=.87, p<.001; Q4: HR=.89, p<.001), and worse survival (Q1: ref, Q2: HR=1.08, p=.054; Q3: HR=1.17, p<.001; Q4: HR=1.20, p<.001). Conclusions: In this large cohort of hospitalized patients with cancer, we identified factors associated with socioeconomic deprivation, such as age, race, comorbid conditions, and cancer type. Importantly, we found patients residing in socioeconomically deprived areas experienced worse outcomes, including longer length of stay and worse overall survival (notably ADI was associated with lower risk of readmission, which is hypothesis-generating). Further understanding of structural barriers and how they correlate with outcomes of hospitalized patients with cancer is necessary to enhance care delivery and outcomes in socioeconomically vulnerable individuals.