Associations between neighborhood socioeconomic status, readmission, and mortality for patients with cancer: A nationwide cohort study.

BACKGROUND: Cancer presents a disproportionate burden, particularly among individuals from low socioeconomic status neighborhoods. Disparities in outcomes persist, influenced by limited access to healthcare services, cultural barriers, and neighborhood socioeconomic status. This nationwide study aimed to investigate the associations between neighborhood socioeconomic status and mortality/readmission among hospitalized Medicare-eligible patients with cancer. METHODS: We conducted a retrospective cohort study of patients with cancer who were hospitalized between 2020 and 2022, using United States (U.S.) Medicare claims data. We used logistic regression models to explore the association between neighborhood socioeconomic status, measured via the corrected Duke Area Deprivation Index, and 1) 30-day mortality and 2) hospital readmission rates. Odds ratios were calculated to assess for associations in a stepwise manner after adjusting for sociodemographic characteristics, comorbidities, and regional/hospital characteristics. RESULTS: The study included 266,269 admissions. Patients from neighborhoods with a higher area deprivation index (i.e., lower socioeconomic status) exhibited higher mortality rates (adjusted odds ratio 1.06 [95 % confidence interval 1.01, 1.12]) compared to patients from lower area deprivation index neighborhoods. There were no overall differences in readmission rates for patients from high area deprivation index neighborhoods. High area deprivation index neighborhoods were associated with less teaching hospitals (30.2 % vs 39.9 %), more public hospitals (16.4 % vs 11.2 %), and less primary care providers (mean 66 vs 93.2) when compared to low area deprivation index neighborhoods. CONCLUSION: The study revealed significant associations between neighborhood socioeconomic status and mortality in patients with cancer in the U.S. Understanding the interplay between neighborhood socioeconomic status and oncologic outcomes is crucial for developing targeted interventions to provide equitable oncology care.

Duke Scholars

Author Bradley Gordon Hammill Population Health Sciences

Author Caroline Sloan Medicine, General Internal Medicine