Assistant Professor Johns Hopkins University School of Medicine Baltimore, Maryland, United States
Disclosure(s):
Debraj Mukherjee, MD, MPH: No financial relationships to disclose
Introduction: Social determinants of health (SDoH) including neighborhood disadvantage have been shown to impact health outcomes throughout medicine. This study investigates the impact of three different neighborhood disadvantage indices, namely Neighborhood Socioeconomic Status (NSES), Area Deprivation Index (ADI), and Distressed Communities Index (DCI), upon post-operative outcomes in glioblastoma (GBM).
Methods: Adult (≥18 years) operative GBM patients from a single center were identified (2007-2020). NSES, ADI, and DCI were identified via patient street address. Model discrimination was assessed using area under the receiver operating curve (AUROC); DeLong test identified significant differences between AUROCs. Multivariate logistic regressions were utilized to identify associations between indices and outcomes.
Results: A total of 467 patients were included (mean age: 59.85±13.21 years, male: 58.7%) with mean NSES, ADI, and DCI scores of 63.45±14.80, 30.52±23.02, and 31.61±25.02, respectively. Twenty-three (23%) patients had extended LOS, 29% had 90-day mortality, and 19% had non-initiation of Stupp protocol. Disadvantaged (low) NSES was correlated with low KPS (P=0.001), high ASA (P=0.012), and high mFI-5 scores (P=0.038). Deprived (high) ADI was correlated with low KPS (P=0.001) and high ASA (P=0.018). Distressed (high) DCI was correlated with low KPS (P=0.001).
NSES had significantly greater AUROC than DCI for 90-day mortality and non-initiation of Stupp protocol but a nonsignificantly higher AUROC than ADI for the referenced outcomes. In multivariate analysis, NSES was significantly associated with extended LOS (OR=0.982, P=0.049). NSES and ADI were significantly associated with 90-day mortality (OR=0.975, P=0.030, and OR=1.016, P=0.014, respectively) and non-initiation of Stupp protocol (OR=0.973, P=0.008, and OR=1.013, P=0.028, respectively). DCI was not predictive of any of these outcomes in the multivariate models.
Conclusion : GBM patients with greater neighborhood disadvantage demonstrated greater LOS, higher mortality, and limited postoperative care. NSES and ADI are valuable measures of neighborhood disadvantage that may be used to design better care pathways for high-risk patients.
