Study shows patients in low socioeconomic status neighborhoods start cancer treatment later—and die sooner—than those in higher-status areas

Dr. Jenny Guadamuz

Dr. Jenny S. Guadamuz.

Cancer patients who live in low socioeconomic status neighborhoods die an average of eight months earlier than those in higher-status neighborhoods with the same disease, according to a study led by Dr. Jenny S. Guadamuz, assistant professor of Health Policy and Management at UC Berkeley School of Public Health.

The retrospective study, published in JNCI Cancer Spectrum in October,  drew on electronic health records derived from anonymized data of nearly 292,000 people, linked to U.S. Census Bureau reports. Researchers analyzed patient records for 20 common types of cancer, which comprise three-quarters of all U.S. cases each year.

Research found that lower area-level socioeconomic status was associated with worse mortality for 19 cancers. Along with inequity in mortality rates, researchers observed unfairness in cancer treatment – with lower-status patients beginning treatment later after their diagnoses, or receiving suboptimal care – for nine of the 20 types of cancer studied.

“Socioeconomic status and wealth shouldn’t give you more access to cancer health care,” said Guadamuz. “You can hypothesize that patients who live in these neighborhoods with low socioeconomic status experience greater financial toxicity, and the costs of cancer care to them are a much greater burden than for someone living with more wealth and income.”

The researchers wrote that differences in death rates were most pronounced among patients with follicular lymphoma (a type of blood cancer), advanced endometrial cancer (cancer of the lining of the uterus), and advanced melanoma (a type of skin cancer”. Follicular lymphoma patients who lived in lower socioeconomic areas had an 84% higher risk of death than those in higher socioeconomic neighborhoods, for example.

Although some prior studies have shown the impact of poverty, unemployment, education status, and other socioeconomic factors on cancer outcomes, Guadamuz said, most of that research is now outdated. In addition, she said, previous studies have generally measured patients in counties that included both low- and high-level socioeconomic neighborhoods. In contrast, Guadamuz’s team studied 72,000 official census tracts of about 4,000 people each, giving them more precise data on neighborhood economic marginalization.

Patients living in low socioeconomic status areas were younger, more likely to be non-Latinx Black or Latinx, live in the South, be seen at community-based centers, and be Medicaid insured than those in  high-socioeconomic status areas, the authors wrote.

The authors noted that the largest treatment inequities were observed among patients with advanced endometrial cancer, with a treatment initiation time of 91 days, compared to 76 days in the higher status neighborhood.

Guadamuz would like to see policy changes that would encourage better cancer care in low socioeconomic status neighborhoods.

“To improve cancer care in economically marginalized neighborhoods, policymakers should consider interventions at multiple levels,” she said. “For example, insurers could reimburse services that address barriers to cancer care, such as navigation assistance to connect patients to financial aid. Federal policies should address the persistent underinvestment in healthcare systems that serve historically marginalized communities.”

Read the full paper here.

Additional co-authors include: Xiaoliang Wang, Cleo A. Ryals, Rebecca A. Miksad, Jeremy Snider, and James Walters, from Flatiron Health; and Gregory S. Calip, affiliated with both Flatiron Health and the USC School of Pharmacy.   

Funding and Disclosures: This work was funded by Flatiron Health, which is an independent member of the Roche Holding AG. All authors report current or previous employment with Flatiron health, and stock ownership in Roche. Dr Miksad and Dr Snider report equity ownership in Flatiron Health, Inc (initiated before acquisition by Roche in 2018).