Socioeconomic, Race-Ethnicity, Household, and Infrastructure Disparities of Hematologic Cancer Outcomes in the US

Although social determinants of health (SDoH) investigations have shown limited analyses of socioeconomic and race-ethnic status on certain hematologic malignancies, the impact of factors beyond those across a fuller scope of hematologic cancers remains unknown. The Social Vulnerability Index (SVI), a tool for assessing varied US-census derived sociodemographic factors, allows the specific quantification of SDoH in dynamic, regional contexts for their associations with hematologic-malignancy inequities. To assess the summative influence of varied SDoH-factors on hematologic malignancy outcomes and discern which SDoH-factors contributed the largest associations towards disparities 796,005 adults with hematologic malignancies between 1975-2017 were identified for this retrospective cohort study. Vulnerability in 15 SDoH-factors was measured using composite and subcategory SVI scores geographically matched to patients. Regressions between SVI factors and follow-up time after diagnosis and survival period were performed. Increasing overall SVI correlated with significantly decreased surveillance period in 11/14 hematologic malignancies, with decreases upwards of 33.4% (39.0 to 26.0 months-acute lymphocytic leukemia). Increasing SVI significantly associated with decreased survival period across 11/14 hematologic malignancies, with decreases upwards of 47.2% (89.5 to 47.3 months-Hodgkins). Socioeconomic status and housing-transportation-vulnerabilities showed the largest-magnitude contributions, followed by minority-language and household composition. Significant decreases in hematologic-malignancy prognosis associate with increasing overall SDoH-vulnerability in varied sociodemographic contexts in the US. Furthermore, there are quantifiable differences in which types of SDoH contribute more to trends per malignancy-type. These findings demonstrate specific SDoH-targets for further research and policy-initiatives to combat hematologic-malignancy disparity more effectively.