E161: Social Vulnerability Is Associated With Increased Oncologic Stage and Differences in Treatment Amongst Cancers in the United States

Growing evidence supports the impact of sociodemographics on cancer outcomes. Most studies have focused on individual sociodemographic characteristics, such as race, ethnicity, or insurance status. This study aimed to examine a broader sociodemographic measure, the Social Vulnerability Index (SVI), and its association with oncologic presentation and subsequent treatments, including 8 major cancer types treated in a single healthcare system.


Methods: This was a retrospective cohort study using on health care system’s contribution to the National Cancer Database data (2011–2021). Patients with breast, lung, colorectal, pancreatic, hepatobiliary, gastric, esophageal and cervical cancer were included and grouped into low SVI (< 75th percentile) or high SVI (≥75th percentile) cohorts. Patients were also grouped into cancers that have national screening protocols versus those without. Demographic, oncologic, and treatment variables were compared between patients with high and low SVI. Multivariable logistic regression was also performed for these comparisons, to control for other demographic characteristics, comorbidity, and cancer type for oncologic presentation, and these factors plus oncologic presentation for subsequent treatments.

Results: Of 12,712 cases, 2,842 (22.4%) were in the high SVI group and 9,870 (77.6%) were in the low SVI group. After risk-adjustment, high SVI patients presented at more advanced T stage (odds ratio OR=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). Following risk-adjustment, high SVI patients were more frequently not recommended for surgery (1.15, 1.01-1.32) or chemotherapy (1.20, 1.07-1.38), see table. Screening protocols tended to increase the association between high SVI and advanced oncologic presentation and reduce the association between high SVI and more frequency of not recommending surgery or chemotherapy.

Conclusions: High SVI was associated with advanced stage presentation of cancer and decreased likelihood of being recommended surgery or chemotherapy even after risk-adjustment. Screening protocols tended to increase the association between high SVI and advanced oncologic presentation but decrease the association between high SVI and decreased likelihood of being recommended for surgery or chemotherapy.