Impact of adverse social determinants of health on long-term mortality and comorbidities in patients with cancers of the lip, oral cavity, and pharynx: A propensity score–matched cohort study using federated electronic health records.

Abstract

e18124 Background: Social determinants of health (SDOH), encompassing socioeconomic and environmental factors, are pivotal in modulating cancer outcomes, yet their long-term implications in head and neck cancers, particularly cancers of the lip, oral cavity, and pharynx (CLOP), remain inadequately characterized amid rising disparities in oncology care. This study investigates the association between adverse SDOH and clinical outcomes in patients with CLOP. Methods: This retrospective, propensity score-matched cohort study utilized data from the TriNetX network, comprising electronic medical records from 88 healthcare organizations. Adults (aged ≥18 years) with CLOP (ICD-10-CM: C00-C14) were stratified into cohorts without (n = 265,544) and with (n = 6,235) adverse SDOH (ICD-10-CM Z59/Z60 codes for housing instability, food insecurity, low income, transportation barriers, and social environment issues). Propensity score matching (1:1) balanced cohorts (n=5430 each) on demographics, BMI, comorbidities, and Eastern Cooperative Oncology Group performance status. The index event was initial CLOP diagnosis and outcomes were assessed from 1-day post-index onward. Analyses included measures of association, Kaplan-Meier survival with log-rank tests and hazard ratios (HRs; Cohort 2 [SDOH] vs Cohort 1 [non-SDOH]), with statistical significance at p<0.05. Results: Matched cohorts were balanced (mean [SD] age, 64 [14] years; 66% male; 63% White). Adverse SDOH was associated with increased mortality (risk, 30.3% vs 25.4%; risk difference, 0.050 [95% CI, 0.032-0.067]; P < .001; HR, 1.76 [95% CI, 1.63-1.89]; P = .038; median survival, 2057 vs 5111 days). Severe sepsis risk was higher with SDOH (6.7% vs 5.7%; risk difference, 0.010 [95% CI, 0.000-0.019]; P = .04; HR, 1.69 [95% CI, 1.44-1.98]; P = .035). Multiple conditions demonstrated comparable associations with worse survival: respiratory disease (HR, 1.23 [95% CI, 1.10-1.39]; P = .38), malnutrition (HR, 1.30 [95% CI, 1.17-1.45]; P = .62), acute kidney failure/CKD (HR, 1.39 [95% CI, 1.24-1.56]; P = .006), infectious diseases (HR, 1.47 [95% CI, 1.33-1.62]; P = .66), and metabolic disorders (HR, 1.27 [95% CI, 1.13-1.42]; P = .11). Dysphagia risk was lower with SDOH (25.6% vs 32.0%; risk difference, -0.064 [95% CI, -0.086 to -0.043]; P < .001; HR, 0.88 [95% CI, 0.81-0.97]; P = .073). Mental/behavioral disorder risk was lower with SDOH (25.4% vs 28.8%; risk difference, -0.034 [95% CI, -0.065 to -0.003]; P = .04; HR, 1.22 [95% CI, 1.06-1.40]; P = .03). Conclusions: Adverse SDOH significantly worsen long-term survival and select morbidity risks in CLOP patients, highlighting the need for multifaceted interventions integrating social support into oncologic frameworks to mitigate disparities and improve equitable oncology care.