Disparities in Stage at Diagnosis and Cancer Progression by Race and Socioeconomic Deprivation: A Pan-Tumor Analysis in the US Community Oncology Setting.

Abstract

Purpose: Understanding the impact of social determinants of health (SDOH) is essential for addressing cancer disparities. This study evaluated race and area deprivation index (ADI) as proxies for social determinants of early-stage diagnosis and time to metastasis or death (TTMd) among patients with non-metastatic cancers at presenting diagnosis in US community oncology settings.

Methods: This was a retrospective observational cohort study of patients with non-metastatic head and neck squamous cell carcinoma (HNSCC); non-small cell lung cancer (NSCLC); triple-negative (TNBC) or hormone receptor-positive (HR +) breast cancer (BC); gastric, bladder or kidney cancer; or melanoma. Patients were indexed at earliest available cancer diagnosis between 1/1/17-6/30/22 and followed through 6/30/23. Stage within 90 days of the presenting diagnosis and TTMd were assessed by tumor type, race and ADI quintiles. Cox proportional hazards modeling with adjusted hazard ratios (aHR) was used to evaluate associations between race and ADI and TTMd across tumors.

Results: Overall, 109,935 patients were included (54% breast, 20% NSCLC, 26% other). Across several tumor types, a higher proportion of Stage III cancer was observed at presenting diagnosis among Black vs. White patients and with increasing ADI quintiles. Shorter TTMd was associated with higher ADI (Q5, most deprived vs. Q1, least deprived: aHR 1.20, 95% CI 1.15-1.26, P < 0.01; Q4 vs. Q1: aHR 1.18, 95% CI 1.11-1.22, P < 0.01) and Black race (vs. White: aHR 1.07, 95% CI 1.03-1.12, P < 0.01), and these associations varied by tumor type.

Conclusion: Black race and socioeconomic deprivation (as measured by the ADI) were associated with more advanced disease at presenting diagnosis and shorter TTMd across multiple tumors. The magnitude of disparities varied across tumor types.