The association between social vulnerability and oncologic stage and treatment in the United States

Abstract

Objective

Growing evidence supports the impact of sociodemographics on cancer outcomes. The objective of this study was to examine the Social Vulnerability Index (SVI) and its association with oncologic presentation and subsequent treatments across 8 major cancers.

Methods

This was a retrospective-cohort study using one institution’s contribution to the National Cancer Database (2011–2021). Patients were grouped into low SVI (<75th percentile) and high SVI (≥75th percentile) cohorts. Un-adjusted comparison between groups was performed followed by multivariable regression to control for the effect of demographic characteristics on oncologic presentation, and for demographic and oncologic characteristics on subsequent treatments. A subgroup analysis was performed comparing cancers that have national screening protocols versus those without.

Results

Of 12,712 cases, 2842 (22.4%) were in the high SVI group and 9870 (77.6%). After risk-adjustment, high SVI patients presented at more advanced T-stage (odds ratio 1.09, 95% confidence interval 1.00–1.19); N-stage (1.11, 1.01–1.23); M stage (1.16, 1.03–1.30); and overall stage (1.14, 1.04–1.24) and were more frequently not recommended for surgery (1.15, 1.01–1.32) or chemotherapy (1.20, 1.07–1.38). Screening protocols tended to increase the association between high SVI and advanced oncologic presentation. After adjustment high SVI remained significantly associated with decreased odds of survival (0.85, 0.79 - 0.91).

Conclusions

High SVI is associated with advanced stage presentation and decreased likelihood of being recommended surgery or chemotherapy even after risk-adjustment. Differences in presentation stage are predominantly driven by cancers with screening protocols and ultimately high SVI is associated with decreased odds of survival.