Defining the Role of Social Vulnerability in Treatment and Survival in Localized Colon Cancer: A Retrospective Cohort Study

Overview

Journal Ann Surg

Specialty General Surgery

Date 2024 Mar 28

PMID 38545790

Authors

Jennie Meier

Gilbert Murimwa

Mithin Nehrubabu

Adam Yopp

Lisa DiMartino

Amit G Singal

Herbert J Zeh 3rd

Patricio Polanco

Affiliations

Soon will be listed here.

Abstract

Objective: To determine whether variations in Social Vulnerability Index (SVI) are associated with disparities in colon cancer surgery and mortality.

Summary Background Data: Colon cancer mortality is influenced by health care access, which is affected by individual and community-level factors. Prior studies have not used the SVI to compare surgical access and survival in localized colon cancer patients. Further, it is unclear if those above 65 years are more vulnerable to variations in SVI.

Methods: We queried the Texas and California Cancer Registries from 2004-2017 to identify patients with localized colonic adenocarcinoma and categorized patients into <65 and ≥65 years. Our outcomes were survival and access to surgical intervention. The independent variable was census tract social vulnerability index, with higher scores indicating more social vulnerability. We used multivariable logistic regression and Cox proportional hazards for analysis.

Results: We included 73,923 patients with a mean age of 68.6 years (SD 13.0), mean SVI of 47.2 (SD 27.6), and 51.1% male. After adjustment, increasing SVI was associated with reduced odds of undergoing surgery (OR 0.996; 95% CI 0.995-0.997; P < 0.0001 and increased mortality (HR 1.002; 95% CI 1.001-1.002; P < 0.0001). Patients < 65 years were more sensitive to variation in SVI.

Conclusions: Increased social vulnerability was associated with reduced odds of receiving surgery for early-stage colon cancer as well as increased mortality. These findings amplify the need for policy changes at the local, state, and federal level to address community-level vulnerability to improve access to surgical care and reduce mortality.

References

Abbas A, Hyer J, Pawlik T . Race/Ethnicity and County-Level Social Vulnerability Impact Hospice Utilization Among Patients Undergoing Cancer Surgery. Ann Surg Oncol. 2020; 28(4):1918-1926. DOI: 10.1245/s10434-020-09227-6. View

von Elm E, Altman D, Egger M, Pocock S, Gotzsche P, Vandenbroucke J . The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007; 370(9596):1453-7. DOI: 10.1016/S0140-6736(07)61602-X. View

Nabi J, Tully K, Cole A, Marchese M, Cone E, Melnitchouk N . Access denied: The relationship between patient insurance status and access to high-volume hospitals. Cancer. 2020; 127(4):577-585. DOI: 10.1002/cncr.33237. View

Rawla P, Sunkara T, Barsouk A . Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Prz Gastroenterol. 2019; 14(2):89-103. PMC: 6791134. DOI: 10.5114/pg.2018.81072. View

Yabroff K, Reeder-Hayes K, Zhao J, Halpern M, Lopez A, Bernal-Mizrachi L . Health Insurance Coverage Disruptions and Cancer Care and Outcomes: Systematic Review of Published Research. J Natl Cancer Inst. 2020; 112(7):671-687. PMC: 7357319. DOI: 10.1093/jnci/djaa048. View

Coronado G, Petrik A, Vollmer W, Taplin S, Keast E, Fields S . Effectiveness of a Mailed Colorectal Cancer Screening Outreach Program in Community Health Clinics: The STOP CRC Cluster Randomized Clinical Trial. JAMA Intern Med. 2018; 178(9):1174-1181. PMC: 6142956. DOI: 10.1001/jamainternmed.2018.3629. View

Nolte E, McKee C . Measuring the health of nations: updating an earlier analysis. Health Aff (Millwood). 2008; 27(1):58-71. DOI: 10.1377/hlthaff.27.1.58. View

Chakrabarti S, Peterson C, Sriram D, Mahipal A . Early stage colon cancer: Current treatment standards, evolving paradigms, and future directions. World J Gastrointest Oncol. 2020; 12(8):808-832. PMC: 7443846. DOI: 10.4251/wjgo.v12.i8.808. View

Ganatra S, Dani S, Kumar A, Khan S, Wadhera R, Neilan T . Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States. JACC CardioOncol. 2022; 4(3):326-337. PMC: 9537091. DOI: 10.1016/j.jaccao.2022.06.005. View

10.

Jacobs P . The Impact Of Medicare On Access To And Affordability Of Health Care. Health Aff (Millwood). 2021; 40(2):266-273. DOI: 10.1377/hlthaff.2020.00940. View

11.

Wild L, Walters M, Powell A, James K, Corlin L, Alderete T . County-Level Social Vulnerability Is Positively Associated with Cardiometabolic Disease in Colorado. Int J Environ Res Public Health. 2022; 19(4). PMC: 8872484. DOI: 10.3390/ijerph19042202. View

12.

Siegel R, Miller K, Fuchs H, Jemal A . Cancer statistics, 2022. CA Cancer J Clin. 2022; 72(1):7-33. DOI: 10.3322/caac.21708. View

13.

Jain V, Al Rifai M, Khan S, Kalra A, Rodriguez F, Samad Z . Association Between Social Vulnerability Index and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study. J Am Heart Assoc. 2022; 11(15):e024414. PMC: 9375494. DOI: 10.1161/JAHA.121.024414. View

14.

Jones R, Devers K, Kuzel A, Woolf S . Patient-reported barriers to colorectal cancer screening: a mixed-methods analysis. Am J Prev Med. 2010; 38(5):508-16. PMC: 2946825. DOI: 10.1016/j.amepre.2010.01.021. View

15.

Lasser K, Murillo J, Medlin E, Lisboa S, Valley-Shah L, Fletcher R . A multilevel intervention to promote colorectal cancer screening among community health center patients: results of a pilot study. BMC Fam Pract. 2009; 10:37. PMC: 2694166. DOI: 10.1186/1471-2296-10-37. View

16.

Segal D, Grabel Z, Shi W, Gottschalk M, Boden S . The impact of insurance coverage on access to orthopedic spine care. J Spine Surg. 2018; 4(2):260-263. PMC: 6046315. DOI: 10.21037/jss.2018.05.22. View

17.

Wang J, Moehring J, Stuhr S, Krug M . Barriers to colorectal cancer screening in Hispanics in the United States: an integrative review. Appl Nurs Res. 2013; 26(4):218-24. DOI: 10.1016/j.apnr.2013.08.005. View

18.

Motairek I, Janus S, Hajjari J, Nasir K, Khan S, Rajagopalan S . Social Vulnerability and Excess Mortality in the COVID-19 Era. Am J Cardiol. 2022; 172:172-174. PMC: 8979474. DOI: 10.1016/j.amjcard.2022.03.011. View

19.

Herb J, Dunham L, Stitzenberg K . A Comparison of Area-Level Socioeconomic Status Indices in Colorectal Cancer Care. J Surg Res. 2022; 280:304-311. DOI: 10.1016/j.jss.2022.07.036. View

20.

Theiss L, Lucy A, Bergstresser S, Chu D, Kennedy G, Hollis R . Disparities in Surgical Timing and Guideline-Adherent Staging Work-Up for Colon Cancer. Ann Surg Oncol. 2022; 29(9):5843-5851. DOI: 10.1245/s10434-022-11938-x. View