Socioeconomic Status and Inequities In Treatment Initiation and Survival Among Patients With Cancer, 2011-2022
Menée aux Etats-Unis à partir de données 2011-2022 portant sur 291 419 patients atteints d'un cancer (20 localisations ; âge médian : 68 ans), cette étude de cohorte rétrospective analyse l'influence du statut socioéconomique sur les traitements anticancéreux et la survie
Lower neighborhood socioeconomic status (SES) is associated with suboptimal cancer care and reduced survival. However, most studies examining cancer inequities across area-level SES tend to use less granular/unidimensional measures and pre-date the coronavirus disease (COVID-19) pandemic. Here we examined the association of area-level SES on real-world treatment initiation and overall survival (rwOS) among adults with 20 common cancers.Retrospective cohort study using electronic health record-derived de-identified data (Flatiron Health Research Database, 2011-2022) linked to Census data from the American Community Survey (2015-2019). Area-level SES quintiles (based on a measure incorporating income, home values, rental costs, poverty, blue-collar employment, unemployment, and education information) were computed from the US population and applied to patients based on their address. Associations were examined using Cox proportional hazards models adjusted for diagnosis year, age, sex, performance status, stage, and cancer type.This cohort included 291,419 patients (47.7% female, median age: 68 years). Patients from low-SES areas were younger and more likely to be Black (21.9% vs 3.3%) or Latinx (8.4% vs 3.0%) vs high-SES areas. Living in low-SES areas (vs high) was associated with lower treatment rates (hazard ratio [HR] 0.94 [95% confidence interval [CI]: 0.93-0.95]) and reduced survival (median rwOS 21.4 vs 29.5 months, HR 1.20 [CI : 1.18-1.22]). Treatment and survival inequities were observed in 9 and 19 cancer types, respectively. Area-lexl remained statistically significant in the COVID-19 era (post-March 2020).To reduce inequities in cancer outcomes, efforts that target marginalized, low-SES neighborhoods are necessary.