Novel patient-level social determinants of health measure predicts colon cancer outcomes within an integrated health network.
Traditional social determinants of health measures rely on population-level data, limiting the ability to assess individual patient-level factors. This study explores the influence of a novel, patient-level social determinants of health measure on oncologic outcomes in patients with colon cancer.
Using a program developed within our integrated health network, which prospectively captures 13 specific patient-level social determinants of health components, we categorized patients as high-risk social determinants of health if they reported significant impairments in any social determinants of health domain. We evaluated the independent effect of high-risk social determinants of health on oncologic outcomes among patients with adenocarcinoma of the colon from 2020 to 2023.
Among 717 patients, the mean age was 67.9 ± 13.6 years, with 54.7% (n = 392) male and 90.8% (n = 651) White; 16.2% had a Charlson Comorbidity Index >2 and 21.3% (n = 128) had stage IV disease at diagnosis. Median overall survival for the cohort was 50.0 (28.0-55.0) months. Overall, 24.0% (n = 172) of patients presented with high-risk social determinants of health. Patients in the 2 cohorts were similar in sex, race, and Charlson Comorbidity Index (P > .050). On multivariable analysis, high-risk social determinants of health was an independent predictor of stage IV disease at diagnosis (odds ratio, 2.32; 95% confidence interval, 1.45-3.73; P < .001) and mortality among all patients (hazard ratio, 1.81; 95% confidence interval, 1.16-2.85; P = .010). Among early stage patients (stage I-II), high-risk social determinants of health was an independent predictor of mortality (hazard ratio, 4.61; 95% confidence interval, 1.67-12.69; P = .003).
Utilizing a novel prospective measure, patient-level social determinants of health independently predicts metastatic disease at diagnosis as well as stage-specific survival in colon cancer. This presents an opportunity to identify specific cancer patients at high risk for poor oncologic outcomes who may benefit from directed care measures.
Using a program developed within our integrated health network, which prospectively captures 13 specific patient-level social determinants of health components, we categorized patients as high-risk social determinants of health if they reported significant impairments in any social determinants of health domain. We evaluated the independent effect of high-risk social determinants of health on oncologic outcomes among patients with adenocarcinoma of the colon from 2020 to 2023.
Among 717 patients, the mean age was 67.9 ± 13.6 years, with 54.7% (n = 392) male and 90.8% (n = 651) White; 16.2% had a Charlson Comorbidity Index >2 and 21.3% (n = 128) had stage IV disease at diagnosis. Median overall survival for the cohort was 50.0 (28.0-55.0) months. Overall, 24.0% (n = 172) of patients presented with high-risk social determinants of health. Patients in the 2 cohorts were similar in sex, race, and Charlson Comorbidity Index (P > .050). On multivariable analysis, high-risk social determinants of health was an independent predictor of stage IV disease at diagnosis (odds ratio, 2.32; 95% confidence interval, 1.45-3.73; P < .001) and mortality among all patients (hazard ratio, 1.81; 95% confidence interval, 1.16-2.85; P = .010). Among early stage patients (stage I-II), high-risk social determinants of health was an independent predictor of mortality (hazard ratio, 4.61; 95% confidence interval, 1.67-12.69; P = .003).
Utilizing a novel prospective measure, patient-level social determinants of health independently predicts metastatic disease at diagnosis as well as stage-specific survival in colon cancer. This presents an opportunity to identify specific cancer patients at high risk for poor oncologic outcomes who may benefit from directed care measures.
Authors
Khan Khan, Boyev Boyev, Joseph Joseph, Gilberti Gilberti, Anees Anees, Schumacher Schumacher, LeJeune LeJeune, Barrett Barrett, Bartlett Bartlett, Allen Allen
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