Neighborhood-level social determinants of health burden among adolescent and young adult cancer patients and impact on overall survival

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Abstract

Background

Neighborhood socioeconomic deprivation has been linked to adverse health outcomes, yet it is unclear whether neighborhood-level social determinants of health (SDOH) measures affect overall survival in adolescent and young adult patients with cancer.

Methods

This study used a diverse cohort of adolescent and young adult patients with cancer (N = 10 261) seen at MD Anderson Cancer Center. Zip codes were linked to Area Deprivation Index (ADI) values, a validated neighborhood-level SDOH measure, with higher ADI values representing worse SDOH.

Results

ADI was statistically significantly worse ( P < .050) for Black (61.7) and Hispanic (65.3) patients than for White patients (51.2). Analysis of ADI by cancer type showed statistically significant differences, mainly driven by worse ADI in patients with cervical cancer (62.3) than with other cancers. In multivariable models including sex, age at diagnosis, cancer diagnosis, and race and ethnicity, risk of shorter survival for people residing in neighborhoods with the least favorable ADI quartile was greater than for individuals in the most favorable ADI quartile (hazard ratio = 1.09, 95% confidence interval = 1.00 to 1.19, P = .043).

Conclusion

Adolescent and young adult patients with cancer and the worst ADI values experienced a nearly 10% increase in risk of dying than patients with more favorable ADI values. This effect was strongest among White adolescent and young adult survivors. Although the magnitude of the effect of ADI on survival was moderate, the presence of a relationship between neighborhood-level SDOH and survival among patients who received care at a tertiary cancer center suggests that ADI is a meaningful predictor of survival. These findings provide intriguing evidence for potential interventions aimed at supporting adolescent and young adult patients with cancer from disadvantaged neighborhoods.

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Most cited references 50

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Making Neighborhood-Disadvantage Metrics Accessible — The Neighborhood Atlas

William R. Buckingham, Amy J.H. Kind (2018)

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Racism and Health: Evidence and Needed Research

David R. Williams, Jourdyn A. Lawrence, Brigette A Davis (2019)

In recent decades, there has been remarkable growth in scientific research examining the multiple ways in which racism can adversely affect health. This interest has been driven in part by the striking persistence of racial/ethnic inequities in health and the empirical evidence that indicates that socioeconomic factors alone do not account for racial/ethnic inequities in health. Racism is considered a fundamental cause of adverse health outcomes for racial/ethnic minorities and racial/ethnic inequities in health. This article provides an overview of the evidence linking the primary domains of racism—structural racism, cultural racism, and individual-level discrimination—to mental and physical health outcomes. For each mechanism, we describe key findings and identify priorities for future research. We also discuss evidence for interventions to reduce racism and describe research needed to advance knowledge in this area.

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Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial.

Diane M Harper, Eduardo L Franco, Cosette M. Wheeler … (2006)

Effective vaccination against HPV 16 and HPV 18 to prevent cervical cancer will require a high level of sustained protection against infection and precancerous lesions. Our aim was to assess the long-term efficacy, immunogenicity, and safety of a bivalent HPV-16/18 L1 virus-like particle AS04 vaccine against incident and persistent infection with HPV 16 and HPV 18 and their associated cytological and histological outcomes. We did a follow-up study of our multicentre, double-blind, randomised, placebo-controlled trial reported in 2004. We included women who originally received all three doses of bivalent HPV-16/18 virus-like particle AS04 vaccine (0.5 mL; n=393) or placebo (n=383). We assessed HPV DNA, using cervical samples, and did yearly cervical cytology assessments. We also studied the long-term immunogenicity and safety of the vaccine. More than 98% seropositivity was maintained for HPV-16/18 antibodies during the extended follow-up phase. We noted significant vaccine efficacy against HPV-16 and HPV-18 endpoints: incident infection, 96.9% (95% CI 81.3-99.9); persistent infection: 6 month definition, 94.3 (63.2-99.9); 12 month definition, 100% (33.6-100). In a combined analysis of the initial efficacy and extended follow-up studies, vaccine efficacy of 100% (42.4-100) against cervical intraepithelial neoplasia (CIN) lesions associated with vaccine types. We noted broad protection against cytohistological outcomes beyond that anticipated for HPV 16/18 and protection against incident infection with HPV 45 and HPV 31. The vaccine has a good long-term safety profile. Up to 4.5 years, the HPV-16/18 L1 virus-like particle AS04 vaccine is highly immunogenic and safe, and induces a high degree of protection against HPV-16/18 infection and associated cervical lesions. There is also evidence of cross protection.

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Author and article information

Contributors

Elizabeth R Rodriguez: Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: VisualizationRole: Writing - original draftRole: Writing - review & editing

Tori Tonn: Role: Data curationRole: Formal analysisRole: ResourcesRole: Writing - review & editing

Midhat Jafry: Role: Data curationRole: Formal analysisRole: ResourcesRole: Writing - review & editing

Sairah Ahmed:

ORCID: https://orcid.org/0000-0001-7302-8299

Role: InvestigationRole: ResourcesRole: Writing - review & editing

Branko Cuglievan: Role: InvestigationRole: ResourcesRole: Writing - review & editing

J Andrew Livingston: Role: InvestigationRole: ResourcesRole: Writing - review & editing

Christopher R Flowers: Role: InvestigationRole: MethodologyRole: ResourcesRole: Writing - review & editing

Gregory J Aune: Role: Funding acquisitionRole: InvestigationRole: ResourcesRole: Writing - review & editing

Karen H Albritton: Role: Funding acquisitionRole: InvestigationRole: ResourcesRole: Writing - review & editing

Michael E Roth: Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: Writing - original draftRole: Writing - review & editing

Qian Xiao:

ORCID: https://orcid.org/0000-0002-8388-1178

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Writing - original draftRole: Writing - review & editing

Michelle A T Hildebrandt:

ORCID: https://orcid.org/0000-0001-6769-6872

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing - original draftRole: Writing - review & editing

Journal

Journal ID (nlm-ta): JNCI Cancer Spectr

Journal ID (iso-abbrev): JNCI Cancer Spectr

Journal ID (publisher-id): jncics

Title: JNCI Cancer Spectrum

Publisher: Oxford University Press

ISSN (Electronic): 2515-5091

Publication date Collection: August 2024

Publication date (Electronic): 25 July 2024

Publication date PMC-release: 25 July 2024

Volume: 8

Issue: 4

Electronic Location Identifier: pkae062