Fei-Zhang David J, Bentrem David J, Wayne Jeffrey D, Hou Lifang, Fei Peiwen, Pawlik Timothy M
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Cancer Med. 2025 Mar;14(5):e70591. doi: 10.1002/cam4.70591.
National social determinant of health (SDoH) studies on gastrointestinal cancers (GIC) have observed single GIC-types for surgery but not across all GIC-types, non-surgical treatments outcomes, or mortality. The Social Vulnerability Index (SVI), a validated large-data SDoH-tool, quantifiably characterizes the interrelatedness of SDoH-impact through dynamic, region-contextualized measures.
This retrospective cohort study assessed GIC patients (20+ years) between 2013 and 2017 from the Surveillance, Epidemiology, and End Results (SEER) database for total and subcomponent social vulnerability associations across 15 SDoH-variables encompassing themes of socioeconomic status, minority-language status, household composition, and housing-transportation measured by the Social Vulnerability Index (SVI). These are measured and contextualized from all US counties. Univariate logistic and linear regressions of these vulnerability associations with treatment receipt (chemotherapy, radiation, primary surgery) and survival were performed for the entire cohort and across race/ethnicity strata.
With increasing overall social vulnerability, 287,248 patients (162,387 [56.5%] male; 185,250 [64.6%] white) demonstrated decreased receipt of chemotherapy (lowest, pancreas-OR, 0.90; 95% CI, 0.88-0.93), radiotherapy (hepatic-OR, 0.87; 95% CI, 0.85-0.89) and surgery (esophagus-OR, 0.90; 95% CI, 0.87-0.92) for 13/14, 10/14, and 8/14 GIC-types, respectively. Survival period decreases upwards of 21.3% (biliary tract: 6.9-5.4 months) were observed across 7/14 GICs. Treatment receipt and survival decreases were exacerbated for non-White patients for 9/14 GICs. Socioeconomic status, minority-language, household composition, and housing-transportation vulnerabilities differentially contributed to these trends.
Social vulnerability was associated with worse prognostic and treatment disparities, with certain SDoH-types differentially contributing to these detrimental trends per GIC-type while associations were exacerbated among non-White race/ethnic patients. These real-world contexts present actionable targets for further initiatives to combat GIC disparities.
关于胃肠道癌症（GIC）的全国健康社会决定因素（SDoH）研究观察了单一GIC类型的手术情况，但未涉及所有GIC类型、非手术治疗结果或死亡率。社会脆弱性指数（SVI）是一种经过验证的大数据SDoH工具，通过动态的、区域背景化的测量方法，可量化地描述SDoH影响的相互关联性。
这项回顾性队列研究评估了2013年至2017年间来自监测、流行病学和最终结果（SEER）数据库的20岁及以上的GIC患者，以探讨15个SDoH变量（涵盖社会经济地位、少数族裔语言状况、家庭构成以及住房和交通等主题）的总体和子成分社会脆弱性关联，这些变量通过社会脆弱性指数（SVI）进行测量。这些数据是对美国所有县进行测量并结合背景情况得出的。对整个队列以及不同种族/族裔分层，进行了这些脆弱性关联与治疗接受情况（化疗、放疗、初次手术）和生存率的单因素逻辑回归和线性回归分析。
随着总体社会脆弱性的增加，287,248名患者（162,387名[56.5%]为男性；185,250名[64.6%]为白人）显示，对于14种GIC类型中的13种、14种中的10种以及14种中的8种，化疗（最低的是胰腺癌，比值比[OR]为0.90；95%置信区间[CI]为0.88 - 0.93）、放疗（肝癌，OR为0.87；95% CI为0.85 - 0.89）和手术（食管癌，OR为0.90；95% CI为0.87 - 0.92）的接受率降低。在14种GIC类型中的7种中，观察到生存期下降超过21.3%（胆管癌：从6.9个月降至5.4个月）。对于14种GIC类型中的9种，非白人患者的治疗接受率和生存率下降更为明显。社会经济地位、少数族裔语言、家庭构成以及住房和交通方面的脆弱性对这些趋势的影响各不相同。
社会脆弱性与较差的预后和治疗差异相关，某些SDoH类型对每种GIC类型的这些有害趋势有不同的影响，而非白人种族/族裔患者之间的关联更为明显。这些实际情况为进一步消除GIC差异的举措提供了可采取行动的目标。
