Association between Area Deprivation Index and Self-Reported Patient Outcomes in Pediatric and Adolescent Cancer Survivors in Louisiana
Authors: Nieves Christian , Sheets Gabrielle , Hunter Tayla , Fang Zhide , Velez Maria C , Tsien Fern , Prasad Pinki 
Published: December 2024

Childhood, adolescent and young adult cancer patients have experienced an increase in survivorship in the last twenty years due to improvements in treatment modalities and supportive care. Despite progress in the treatment of childhood cancer, long-term survivors remain at increased risk for treatment-related chronic health conditions and premature death when compared with the general population. Increasing evidence has shown that different neighborhood characteristics significantly affect healthcare outcomes. Historically, studies examining neighborhood deprivation have used a person's residential zip code as the geographical unit of analysis. More recently, the Area Deprivation Index (ADI), a validated tool, has been used to analyze deprivation more precisely. ADI utilizes census-tract level metrics based on 17 census derived factors with scores range from 1-100 and are grouped in five groups, higher scores correspond to higher deprivation. The association between area-level deprivation and survival in pediatric cancer patients has not been explored. There is limited literature demonstrating the relationship between the impact of ADI on pediatric cancer survivorship and medical follow-up. We investigate ADI scores of pediatric cancer survivors from the Treatment After Cancer and Late Effects Clinic (TACLE) at Children's Hospital New Orleans and the association between patient or parents' self-reported outcomes, including quality of life and access to follow-up health care.

Using information collected from a self-reported questionnaire, based on the Childhood Cancer Survivor Study (CCSS) questionnaire, pediatric cancer survivors or parents/caregivers, if the patient is less than 18 years of age, completed it on their first visit to the TACLE clinic. The cohort included 168 completed health questionnaires, 78 (46%) patients identified as female and 90 (54%) as male, with a mean age of 17 years. All subjects were assigned an ADI score and a grouped in quintiles. We found childhood cancer survivors residing in the most deprived neighborhoods had statistically significantly higher odds ratios of reporting physical limitations after therapy (p = 0.0258). For every increase of 5 points in the ADI score, the odds of reporting a physical problem increase 10% (OR = 1.10, 95% confidence interval (CI) = 1.01, 1.2). Additional variables examined included health care follow-up with a primary care provider, emergency department visits, use of medications after completion of cancer treatment, pain, sleep issues, or insurance were not statistically significant.

Our analysis demonstrated that in this cohort, neighborhood deprivation is negatively associated with follow-up of health care, specifically evaluation after cancer treatment is completed and with reporting of physical problems. As neighborhood deprivation increases, the risk of developing a limitation in daily routine is more likely to occur. Neighborhood deprivation may need to be considered when using patient-reported outcomes. It will be essential to understand the role of area deprivation on patient-reported outcomes in pediatric cancer and the implications on clinical practice.