The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
Ann Surg Oncol. 2023 May;30(5):2620-2628. doi: 10.1245/s10434-023-13099-x. Epub 2023 Jan 25.
Multiple composite indices of small-area socioeconomic characteristics have been used to examine how neighborhood characteristics influence cancer care, but there is little consensus regarding how to use them. This scoping review aimed to summarize the use of these indices in cancer literature and their association with outcomes.
A search was conducted to identify studies from 2015 to 2021 that investigated cancer incidence, disease stage at diagnosis, and mortality using area-based indices of deprivation as an independent variable. Studies were screened and assessed for eligibility. Data were extracted regarding the geospatial and statistical use of these indices.
All the inclusion criteria were met by 45 studies. The area level of analysis was at the census tract level in 19 studies (42.3%), the county level in 15 studies (33.3%), the block group level in 6 studies (13.3%), and the ZIP code level in 5 studies (11.1%). Altogether, 18 unique indices were used, with 4 indices used most frequently. Of the studies that used their indices ordinally, 3 defined high and low deprivation dichotomously, 10 used tertiles, 13 used quartiles, and 15 used quintiles. Of the 45 studies, 34 (76%) showed a significant association between area deprivation and cancer-related outcomes.
Neighborhood deprivation indices are most commonly used at the census tract level and ordinally as quintiles. Despite variance in methods, there is a strong indication that deprived areas are at adverse odds with cancer-related outcomes. Further study investigating deprivation in the context of cancer can inform drivers of inequity and identify potential targets for care delivery and policy interventions.
已经使用多个小区域社会经济特征的综合指数来研究邻里特征如何影响癌症护理，但对于如何使用这些指数，尚未达成共识。本范围综述旨在总结这些指数在癌症文献中的使用情况及其与结果的关联。
进行了一次检索，以确定 2015 年至 2021 年间使用基于区域的贫困指数作为自变量来研究癌症发病率、诊断时疾病分期和死亡率的研究。筛选和评估研究的合格性。提取有关这些指数的地理空间和统计使用的数据。
所有纳入标准均符合 45 项研究。19 项研究（42.3%）的分析级别为普查区，15 项研究（33.3%）为县，6 项研究（13.3%）为街区组，5 项研究（11.1%）为邮政区码。总共使用了 18 个独特的指数，其中 4 个指数使用最频繁。在使用其指数进行有序分析的研究中，有 3 项将高和低贫困程度定义为二分法，10 项使用三分法，13 项使用四分法，15 项使用五分法。在 45 项研究中，34 项（76%）表明地区贫困与癌症相关结局之间存在显著关联。
邻里贫困指数最常用于普查区，且最常以五分位数的形式有序使用。尽管方法存在差异，但有强有力的证据表明贫困地区癌症相关结局较差。进一步研究贫困在癌症背景下的情况可以为不公平的驱动因素提供信息，并确定提供护理和政策干预的潜在目标。
