Impact of neighborhood disadvantage and residential isolation on cognitive outcomes in cancer survivors.

Abstract

12056 Background: The Social Vulnerability Index (SVI), a composite measure of socioeconomic deprivation, household composition, minority status, and housing type and transportation, is a reliable marker of neighborhood disadvantage. Residential Segregation measures the degree to which a minority group is distributed differently than the majority group across census tracts. The isolation index is a measure of segragation that captures the extent to which minority members are exposed only to one another. These measures have been associated with poor survival in patients with cancer, yet studies on adverse outcomes in surviors are limited. Cognitive impairment is an adverse outcome highly prevalent in up to 40% and persists up to 5y in hematologic cancer survivors treated with blood or marrow transplantation (BMT). We postulate that neighbohood disadvantage and residential isolation may have a negative effect on cognitive outcomes in BMT survivors. Methods: We included 71 patients treated with allogeneic BMT, enrolled in the the Cognitive Training and Genetics Attitudes (cTAG) study. Objective cognitive function was measured using a comprehensive in-person battery of standardized neuropsychological tests. Standardized T-scores were categorized as deficit scores (range 0 to 5), and averaged across all tests to estimate a global deficit score(GDS), which was used as a measure of cognitive impairment. Residential addresses, geocoded and joined to corresponding Census block group and tract, were used to match patients with their corresponding SVI and residential segregation scores. Multivariable logistic regression models adjusted for age, sex, race, and clustering at the tract level were used to estimate associations with GDS. Results: Median age at study participation was 58y (IQR: 46, 63), 57.8% were male, and 16.9% were non-Hispanic Black. Primary diagnosis was 66.2% acute leukemia and 22.5 myelodysplastic/myeloproliferative neoplasms. Average time since BMT was 1.5y (SD = 1.2). Prevalence of global cognitive impairment was 19.7% (95%CI: 11.2-30.9). A high overall SVI score was associated with GDS (aOR = 4.7, 95%CI: 1.1, 20.2, p = 0.035). Vulnerability related to socioeconomic status (aOR = 4.9, 95%CI: 1.2, 20.2, p = 0.03) and housing type and transportation (aOR = 4.0, 95%CI: 1.1, 15.2, p = 0.04) were significantly associated with GDS. Higher residential isolation index ( > 0.6) was significantly associated with increase in GDS (aOR = 5.4, 95%CI: 1.3, 22.5, p = 0.02) adjusting for age, sex, race, and clustering at the tract level. Conclusions: Cancer survivors residing in areas with higher indicators of social vulnerability and isolation are at increased risk of cognitive decline post-BMT. These findings highlight the overall need for dedicating appropriate resources and care planning especially for individuals surrounded by others from their same group within their residential areas.