Abstract C057: Neighborhood disadvantage is associated with liver cancer treatment and survival
Authors: Hood Robert B , Felix Ashley 
Published: September 2020

Abstract
Liver cancer is the 5th leading cause of cancer mortality in the United States and is predicted to increase in the US as a consequence of the opioid epidemic. Associations between individual-level risk factors, such as socioeconomic status, and liver cancer survival have been explored; however, the role of neighborhood-level factors, such as neighborhood deprivation, are noticeably absent from the literature. We explored the association between greater neighborhood deprivation and disparities in tumor characteristics, treatment and 5-year survival among primary liver cancer patients in Ohio diagnosed between 2003 and 2016 using data from the Ohio Cancer Incidence Surveillance System. We restricted our sample to only patients who were 18 years older and who could be geographically linked to a census tract based on their address at diagnosis. We created a neighborhood deprivation index (NDI) using nine variables at the Census tract level including: % less than high school diploma, % college graduates, % at or below the federal poverty line, % unemployed, median household income, % vacancy, % owner occupied unites, median house/unit value and % African American. We used principal component analysis to create the index and derived quintiles of deprivation with the higher quintiles reflective of areas with higher deprivation. We examined associations between tumor characteristics and NDI quintile using chi-square tests and ANOVA. We examined concordance with treatment guidelines as binary variable using log-binomial regression. For 5-year survival we utilized Cox proportional hazard models. Confounding variables for each regression model were selected using Directed Acyclic Graphs. After exclusion criteria were applied, 8,208 primary liver cancer patients were included in the study. We observed no statistically significant differences in tumor characteristics by quintile of NDI. However, we found a clear gradient between levels of deprivation and decrease likelihood of receiving guideline-concordant care. Specifically, between the most and least deprived areas, a 25% lower risk (Risk ratio [RR]=0.75; 95% Confidence Interval [CI]=0.67, 0.85) of receiving guideline-concordant care was observed in our adjusted log-binomial regression model. In adjusted survival models we observed an increased risk of death comparing the most and least deprived areas (Hazard ratio [HR]=1.14, 95% CI=1.02, 1.27). Our study suggests a potential negative effect of neighborhood deprivation on treatment concordance and liver cancer survival. Interventions targeting disparities in liver cancer should focus on not only individual level factors but address larger neighborhood level factors as well. Future analyses are needed to confirm these disparities observed and determine if similar neighborhood level effects occur in other cancer disparities. This study includes data provide by the Ohio Department of Health which should not be considered an endorsement of this study or its conclusions.
Citation Format: Robert B Hood, Ashley Felix. Neighborhood disadvantage is associated with liver cancer treatment and survival [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C057.