The Association Between Area Deprivation Index and Patient-Reported Outcomes in Patients with Advanced Cancer

Abstract

Background: This analysis describes associations between area deprivation and patient-reported outcomes among patients with advanced cancer. Methods: This is a cross-sectional analysis of baseline data from a multisite primary palliative care intervention trial. Participants were adult patients with advanced cancer. Patient-level area deprivation scores were calculated using the Area Deprivation Index (ADI). Quality of life and symptom burden were measured. Uni-and multivariate regressions estimated associations between area deprivation and outcomes of interest. Results: Among 672 patients, *0.5 (54%) were women and most (94%) were Caucasian. Mean age was 69.3-10.2 years. Lung (36%), breast (13%), and colon (10%) were the most common malignancies. Mean ADI was 64.0, scale of 1 (low)-100 (high). In unadjusted univariate analysis, Functional Assessment of Cancer Therapy-Palliative (p = 0.002), Edmonton Symptom Assessment Scale (p = 0.025) and the Hospital Anxiety and Depression Scale anxiety (p = 0.003) and depression (p = 0.029) scores were significantly associated with residence in more deprived areas (p = 0.003). In multivariate analysis, controlling for patient-level factors, living in more deprived areas was associated with more anxiety (p = 0.019). Conclusion: Higher ADI was associated with higher levels of anxiety among patients with advanced cancer. Geographic information could assist clinicians with providing geographically influenced social support strategies.

Neighborhood and Individual Socioeconomic Disadvantage and Survival Among Patients With Nonmetastatic Common Cancers

“…Neighborhood disadvantage has been reported to be associated with (1) increased cancer prevalence, incidence, and mortality 8 , 46 ; (2) obesity and inferior overall survival among pediatric patients with acute lymphoblastic leukemia 61 , 62 ; (3) lack of adjuvant therapy among patients with localized pancreatic cancer 63 ; and (4) anxiety among patients with advanced cancer. 64 One SEER study 8 reported higher ADI (neighborhood disadvantage) to be associated with worse overall survival among cancer patients diagnosed between 1988 and 1999: HRs (highest decile vs lowest decile) were 1.68 (95% CI, 1.57-1.79) for breast, 1.57 (95% CI, 1.46-1.68) for prostate, 1.29 (95% CI, 1.23-1.36) for colorectal, and 1.56 (95% CI, 1.54-1.59) for all cancers. However, such survival estimates were not adjusted for cancer stage and treatment and may not accurately reflect the associations of neighborhood disadvantage with cancer survival, given that stage and treatment are key factors influencing the prognosis of cancer patients.…”

“…Neighborhood disadvantage has been reported to be associated with (1) increased cancer prevalence, incidence, and mortality 8,46 ; (2) obesity and inferior overall survival among pediatric patients with acute lymphoblastic leukemia 61,62 ; (3) lack of adjuvant therapy among patients with localized pancreatic cancer 63 ; and (4) anxiety among patients with advanced cancer. 64 One SEER study 8 95% CI, 1.13-1.28), and cancer-specific survival (HR, 1.27; 95% CI, 1.18-1.37), suggesting that even in this group of trial participants who initially all had access to high-quality cancer care, there were still survival disparities across strata of neighborhood SES. Given that all cancer types were combined and separate analyses were not conducted, it was unclear which cancers were primarily subject to neighborhood socioeconomic disadvantage.…”

Sociodemographic Differences in Pain Medication Usage and Healthcare Provider Utilization Among Adults With Chronic Low Back Pain

“…Chronic low back pain (cLBP) refers to a persistent or recurring pain in the lumbar region of the spine to the pelvis ( 8 ) and is the most common reason for individual suffering and utilization of health care services across the lifespan ( 3 ). The experience of pain can be influenced by several factors, including, but not limited to, race, socioeconomic status (SES) and neighborhood-level characteristics, advanced age, and gender ( 9 , 10 ). Mounting evidence suggests disparities and inequities in pain management exist among vulnerable subgroups that are influenced by social determinants of health ( 5 , 7 ).…”

British Columbia’s Index of Multiple Deprivation for Community Health Service Areas

“…Research reported around the world confirms that area-based deprivation indexes are associated with equity in health status and health outcomes measured in terms of morbidity and mortality. Area-based deprivation was found to be associated with higher cancer mortality in Hong Kong, China [25] and with higher levels of anxiety among patients with advanced cancer in the United States [26], while a South Korean study suggested community deprivation levels to influence individual health behaviors [27]. A Northern Ireland study reported a significant correlation of the prescribing of multiple drug classes with socio-economic deprivation levels [28].…”