The role of area deprivation index in health care disruptions among cancer survivors during the SARS-CoV-2 pandemic

• Published in: Public health (London) 2024-07, Vol.232, p.52-60
• Main Authors: Wagner, R.W., Natori, A., Prinsloo, S., Otto, A.K., Saez-Clarke, E., Ochoa, J.M., Tworoger, S.S., Ulrich, C.M., Hathaway, C.A., Ahmed, S., McQuade, J.L., Peoples, A.R., Antoni, M.H., Penedo, F.J., Cohen, L.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Area deprivation index; Cancer; Cancer Survivors - psychology; Cancer Survivors - statistics & numerical data; COVID-19 - epidemiology; Cross-Sectional Studies; Female; Follow-up medical care; Health care access; Health Services Accessibility - statistics & numerical data; Humans; Male; Middle Aged; Neoplasms - epidemiology; Neoplasms - therapy; Pandemics; Quality of Life; Residence Characteristics - statistics & numerical data; SARS-CoV-2; Socioeconomic Factors; Surveys and Questionnaires; Telemedicine - statistics & numerical data
• ISSN: 0033-3506; 1476-5616
• DOI: 10.1016/j.puhe.2024.04.007

To examine the associations between demographic/medical and geographic factors with follow-up medical care and health-related quality of life (HRQoL) among cancer survivors during the SARS-CoV-2 pandemic. Cross-sectional survey. An online survey was sent to cancer survivors between May 2020 and January 2021, exploring their experience with SARS-CoV-2, follow-up care, and HRQoL. PolicyMap was used to geocode home addresses. Both geographic and demographic/medical factors were examined for their associations with SARS-CoV-2 experience, follow-up care, and HRQoL (FACT-G7). Geographic data were available for 9651 participants. Patients living in the highest area deprivation index (ADI) neighborhoods (most deprived) had higher odds of avoiding in-person general (odds ratio [OR] = 7.20; 95% confidence interval [CI] = 2.79–18.60), cancer (OR = 8.47; 95% CI = 3.73–19.30), and emergency (OR = 14.2; 95% CI = 5.57–36.30) medical care, as well as lower odds of using telemedicine (OR = 0.61; 95% CI = 0.52–0.73) compared to the lowest ADI group. Race/ethnicity was not associated with follow-up care after controlling for ADI. The effect of ADI on HRQoL was generally in the expected direction, with higher ADI being associated with worse HRQoL. ADI influenced follow-up medical care more than age, race/ethnicity, or health insurance type. Healthcare providers and institutions should focus on decreasing barriers to in-person and telemedicine health care that disproportionally impact those living in more deprived communities, which are exacerbated by health care disruptions like those caused by the SARS-CoV-2 pandemic.