Socially vulnerable neighborhoods linked to increased risk for death after cancer surgery
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Key takeaways:
- Individuals in the top SVI quartile more likely to be Black and less often have private health insurance.
- Those in the highest SVI quartile had significantly greater mortality risk.
Individuals who ranked highest on a scale measuring social vulnerability by location had a poorer prognosis following colorectal resection, according to a presentation at Southern Surgical Association Annual Meeting.
Patients in the top quartile of the social vulnerability index (SVI) had significantly higher risk for overall and colorectal cancer-related mortality after the immediate postoperative period, study results showed.
Researchers conducted the study to better understand when a patient’s care might be affected due to the area they live in and potential short-term or long-term complications.
“We know that patients have differing rates of screening, treatment and even survival for colorectal cancer by individual social determinants such as race and ethnicity,” Sabran J. Masoud, MD, a member of the general surgery residency program at Duke University School of Medicine, told Healio. “We also know there is evidence that where someone lives, or their community, plays a role in health outcomes,” he added. “However, we have a limited understanding of exactly when in a patient’s care that community vulnerability exerts the greater influence.”
Background, methods
Factors such as race and socioeconomic status do not completely identify patients with colorectal cancer who are at high risk for screening, treatment and mortality disparities, according to background information provided by study investigators.
The SVI assists in delineating neighborhoods that require additional support after accounting for external health stressors.
Therefore, researchers worked to characterize a potential relationship between SVI and colorectal cancer survival.
The study included 872 adults undergoing resection of stage I to stage IV colorectal cancer between January 2010 to May 2023 at an established academic health system.
Researchers abstracted clinicopathologic characteristics and geocoded addresses from electronic health records to SVI to compare OS and cancer-specific survival using the Kaplan-Meier and Cox proportional hazards analysis.
Results
Study subjects in the top SVI quartile (32%) had a greater chance of being Black (41% vs. 13%), less frequently had private health insurance (39% vs. 48%) and experienced greater comorbidity (86% vs. 71%), without significant difference by acuity, stage or colorectal therapy.
A multivariate analysis revealed that high SVI remained associated with higher all-cause (HR = 1.48; 95% CI, 1.12–1.96) and cancer-specific survival (HR = 1.71; 95% CI, 1.1-2.67).
Next steps
Researchers noted that, beyond the perioperative period, high SVI appeared to be independently associated with poorer prognosis after colorectal cancer resection.
They determined that neighborhood-level vulnerability may assist in identifying targeted outreach for colorectal cancer care, with a need to confirm these findings in larger trials.
“It is important to both validate these findings on larger multi-institutional scales, as well as determine the specific mechanisms by which patients in more vulnerable communities are receiving different care,” Masoud told Healio. “In other words, why are more socially vulnerable patients experiencing survival disparities? It will be interesting to see how rates of surveillance adherence, enrollment in clinical trials, salvage therapies after progressive disease, etc., may or may not differ by SVI.”
For more information:
Sabran J. Masoud, MD, can be reached at sabran.masoud@duke.edu.
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Masoud SJ, et al. Social vulnerability index and survivorship after colorectal cancer resection. Presented at: Southern Surgical Association Annual Meeting; Dec. 3-6, 2023; Hot Springs, VA.
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