PATIENT-REPORTED SOCIAL DETERMINANTS OF HEALTH NEEDS DO NOT CORRELATE WITH CENSUS TRACT MEASURES OF SOCIOECONOMIC DISADVANTAGE IN PATIENTS WITH GASTROINTESTINAL CANCERS
Scarlett Hao*1, Ashley Wercholuk1, Patrycja Popowicz1, John A. Iasiello1, Christopher W. Mejia1, Alexander Parikh1, Rebecca A. Snyder1,2
1Surgery, East Carolina University Brody School of Medicine, Greenville, NC; 2ECU School of Public Health, Greenville, NC
Background: Social determinants of health (SDOH) are associated with disparities in patients with gastrointestinal cancer. However, most studies have relied on aggregate measures of socioeconomic disadvantage assigned based on a patient's geographic residence. The correlation of assigned measures of SDOH with individual patient-reported needs has not been previously explored. The primary aim of this study was to evaluate the correlation of patient-reported SDOH needs with census tract measures of aggregate socioeconomic disadvantage.
Methods: A prospective study was performed of all adult patients with gastrointestinal cancers presenting to a large regional cancer center for initial evaluation (11/2020-7/2021). Standardized SDOH screening was administered using the electronic health record (EHR). Patients were assigned an area deprivation index (ADI) and measures of socioeconomic status according to aggregate census tract values based on patient residence. Patient-reported SDOH needs were then correlated with ADI and census tract measures using Spearman rank correlation.
Results: Of 112 patients screened for SDOH, nearly half self-identified as Black (41.1%; n=46) and 50.5% (n=54) resided in a rural county. Median ADI rank was 7 (IQR 5-9) and median household income by census tract was $38,125 (IQR $31,436-$48,934) (Table 1). ADI rank did not correlate with self-reported SDOH needs. Only 12.5% (n=14) of patients self-reported moderate or severe financial need on SDOH screening. Self-reported financial need during SDOH screening correlated with self-reported food insecurity, transportation difficulty, and stress needs (p<0.01). Only census-tract assigned median income and education status correlated with patient self-report of financial need (p<0.05); other individual census tract measures did not correlate with patient-reported needs.
Conclusions: Results of this pilot study of SDOH screening suggest that population-based census tract level measures may not accurately represent or predict patient-reported SDOH needs and highlight the importance of patient-level screening for SDOH in the clinical setting. Further investigation within a larger study population is warranted.
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