The role of area deprivation index in health care disruptions among cancer survivors during the SARS-CoV-2 pandemic

R W Wagner; A Natori; S Prinsloo; A K Otto; E Saez-Clarke; J M Ochoa; S S Tworoger; C M Ulrich; C A Hathaway; S Ahmed; J L McQuade; A R Peoples; M H Antoni; F J Penedo; L Cohen

doi:10.1016/j.puhe.2024.04.007

The role of area deprivation index in health care disruptions among cancer survivors during the SARS-CoV-2 pandemic

Public Health. 2024 May 11:232:52-60. doi: 10.1016/j.puhe.2024.04.007. Online ahead of print.

Authors

R W Wagner¹, A Natori², S Prinsloo³, A K Otto⁴, E Saez-Clarke⁵, J M Ochoa¹, S S Tworoger⁶, C M Ulrich⁷, C A Hathaway⁸, S Ahmed⁹, J L McQuade¹⁰, A R Peoples⁷, M H Antoni¹¹, F J Penedo¹², L Cohen¹³

Affiliations

¹ Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
² Division of Medical Oncology, Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA.
³ Department of Palliative, Rehabilitation and Integrative Medicine, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA.
⁵ Department of Psychology, College of Arts and Sciences, University of Miami, FL, USA.
⁶ Division of Oncological Sciences, Knight Cancer Institute, School of Medicine, Oregon Health and Science University, Portland, OR, USA.
⁷ Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA.
⁸ Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
⁹ Department of Lymphoma and Myeloma, Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹⁰ Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
¹¹ Department of Psychology, College of Arts and Sciences, University of Miami, FL, USA; Department of Psychiatry and Behavioral Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
¹² Department of Psychology, College of Arts and Sciences, University of Miami, FL, USA; Department of Medicine & Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA.
¹³ Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: lcohen@mdanderson.org.

PMID: 38735226
DOI: 10.1016/j.puhe.2024.04.007

Abstract

Objective: To examine the associations between demographic/medical and geographic factors with follow-up medical care and health-related quality of life (HRQoL) among cancer survivors during the SARS-CoV-2 pandemic.

Study design: Cross-sectional survey.

Methods: An online survey was sent to cancer survivors between May 2020 and January 2021, exploring their experience with SARS-CoV-2, follow-up care, and HRQoL. PolicyMap was used to geocode home addresses. Both geographic and demographic/medical factors were examined for their associations with SARS-CoV-2 experience, follow-up care, and HRQoL (FACT-G7).

Results: Geographic data were available for 9651 participants. Patients living in the highest area deprivation index (ADI) neighborhoods (most deprived) had higher odds of avoiding in-person general (odds ratio [OR] = 7.20; 95% confidence interval [CI] = 2.79-18.60), cancer (OR = 8.47; 95% CI = 3.73-19.30), and emergency (OR = 14.2; 95% CI = 5.57-36.30) medical care, as well as lower odds of using telemedicine (OR = 0.61; 95% CI = 0.52-0.73) compared to the lowest ADI group. Race/ethnicity was not associated with follow-up care after controlling for ADI. The effect of ADI on HRQoL was generally in the expected direction, with higher ADI being associated with worse HRQoL.

Conclusions: ADI influenced follow-up medical care more than age, race/ethnicity, or health insurance type. Healthcare providers and institutions should focus on decreasing barriers to in-person and telemedicine health care that disproportionally impact those living in more deprived communities, which are exacerbated by health care disruptions like those caused by the SARS-CoV-2 pandemic.

Keywords: Area deprivation index; Cancer; Follow-up medical care; Health care access; SARS-CoV-2.