Objective

The Social Vulnerability Index (SVI) is a composite metric for social determinants of health. The objective of this study was to determine if SVI influences stage at presentation for non-small cell lung cancer (NSCLC) patients and subsequent therapies.

Materials and methods

NSCLC patients from our local contribution to the National Cancer Database (2011–2021) were grouped into low SVI (<75 %ile) and high SVI (>75 %ile) cohorts. Demographics, cancer-related variables, and treatment modalities were compared. Multivariable logistic regression was performed to control for the impact of demographics on cancer presentation and for the impact of oncologic variables on treatment outcomes.

Results

Of 1,662 NSCLC patients, 435 (26 %) were defined as high SVI. Compared to the 1,227 (74 %) low SVI patients, highly vulnerable patients were more likely to be male (53.3 % vs 46.0 %, p = 0.009), non-White (17.2 % vs 9.7 %, p < 0.0001), have comorbidities (29.4 % vs 23.1 %, p = 0.009) and present at a higher AJCC clinical T, M and overall stage (all p < 0.05). These findings persisted on multivariable analysis, with highly vulnerable patients having 1.5x the odds (95 %CI: 1.23–1.86, p < 0.001) of presenting at more advanced stage. Patients with high SVI were less likely to be recommended for and receive surgery (40.9 % vs 53.2 %, p < 0.001), and this finding persisted after controlling for stage at presentation (OR 1.37, 95 %CI 1.04–1.80).

Conclusions

Highly vulnerable patients present at a more advanced clinical stage and are less likely to be recommended and receive surgery, even after controlling for stage at presentation. Further investigation into these findings is warranted to achieve more equitable oncologic care.

中文翻译：

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社会脆弱性对非小细胞肺癌初期及治疗的影响

客观的

社会脆弱性指数（SVI）是健康问题社会决定因素的综合指标。本研究的目的是确定 SVI 是否影响非小细胞肺癌 (NSCLC) 患者的就诊分期和后续治疗。

材料和方法

我们对国家癌症数据库（2011-2021）本地贡献的 NSCLC 患者被分为低 SVI（<75 %ile）和高 SVI（>75 %ile）队列。比较了人口统计学、癌症相关变量和治疗方式。进行多变量逻辑回归以控制人口统计学对癌症表现的影响以及肿瘤学变量对治疗结果的影响。

结果

在 1,662 名 NSCLC 患者中，435 名 (26%) 被定义为高 SVI。与 1,227 名 (74%) 低 SVI 患者相比，高度易感患者更有可能是男性 (53.3% vs 46.0%，p = 0.009)、非白人 (17.2% vs 9.7%，p < 0.0001)，有合并症（29.4 % vs 23.1 %，p = 0.009）并且处于较高的 AJCC 临床 T、M 和总体分期（所有 p < 0.05）。这些结果在多变量分析中得到证实，高度脆弱的患者出现更晚期的几率是 1.5 倍（95%CI：1.23-1.86，p < 0.001）。高 SVI 的患者被推荐和接受手术的可能性较小（40.9 % vs 53.2 %，p < 0.001），并且在控制就诊时的分期后，这一发现仍然存在（OR 1.37，95 % CI 1.04-1.80）。

结论

高度脆弱的患者处于更晚期的临床阶段，即使在控制了就诊时的阶段之后，也不太可能被推荐和接受手术。有必要对这些发现进行进一步调查，以实现更公平的肿瘤护理。