Abstract PO4-09-06: Area Deprivation Index (ADI) among Patients with Breast Cancer in Buffalo
Authors: Alharbi Malak , Roy Arya Mariam , Patel Archit , Catalfamo Kayla , Attwood Kristopher , Omilian Angela , Bouchard Elizabeth , Levine Ellis , O'Connor Tracey , Early Amy , Gandhi Shipra 
Published: May 2024

Abstract
Introduction:
Socioeconomic and racial disparities can limit access to health care. Prior studies suggest that living in a disadvantaged neighborhood results in poorer outcomes in several malignancies. ADI is an index that categorizes areas based on socioeconomic variables. In this observational study, we aimed to investigate the ADI among patients (pts) with breast cancer (BC) seen at Roswell Park Comprehensive Cancer Center in Buffalo, New York, and study its association with clinical outcomes to identify the areas with the highest unmet need for possible intervention strategies.
Methods:
We reviewed data of 187 pts diagnosed with stages 1-3 and de-novo stage 4 BC between 2014 to 2018. We obtained information on ADI using pts’ home addresses via Neighborhood Atlas tool www.neighborhoodatlas.medicine.wisc.edu. ADI values were categorized into four quartiles Q1(80-100%), Q2(60-79%), Q3(40- 59%), and Q4(0-39%) from highest deprivation/poor social economic status areas to least disadvantaged areas, respectively. Demographic and clinicopathological characteristics including age, race, comorbidities, stage, type of insurance, duration on treatment were compared by ADI. Kruskal-Wallis and Chi-square was used for comparing continuous and categorical variables, respectively. Recurrence free survival (RFS), time to next treatment (TNT), and overall survival (OS) were estimated using Kaplan Meier method. Multivariate Cox regression model was used to analyze outcomes for pts with stage 4 in the most disadvantaged areas (ADI ≥60%) adjusting for relevant covariates. Analyses were performed using SAS v9.4 at a significance level of &lt; 0.05.
Results:
98% pts (183/187) were females, 85% (160/187) Whites, 9% (17/187) African Americans, and 3% (6/187) Asians. 62% (116/187) lived in the most disadvantaged areas: 37% (70/187) in Q1, and 24% (46/187) in Q2, while 27% (51/187) lived in Q3, and 11% (n=20/187) in Q4. 80% (150/187) pts were diagnosed with hormone receptor positive BC, 18% (34/187) HER2 positive, and 15% (28/187) triple negative BC. 45% of pts (83/187) had de novo stage 4, the rest were diagnosed with stages 1-3. There was no difference in the distribution of age, race, employment, insurance, comorbidities, substance use, smoking, access to contraception, screening mammogram, or adherence to anti-estrogen and radiation therapy by ADI. There was a significant difference in adherence to chemotherapy/anti HER2 therapy: 92% (36/39) in Q1,100% (24/24) in Q2 vs. 85% (24/28) in Q3 and 67% (6/9) in Q4, p=0.029. Among pts with stages 1-3, there was no difference in RFS (p= 0.700) or OS (p= 0.400) by ADI. Among stage 4 patients, there was an association between TNT and ADI, where patients living where there was a trend towards worse survival with increasingly disadvantaged neighborhoods, p=0.008 (Table 1). Moreover, there was a significant difference in OS by ADI, p=0.03 (Table 2). There was a significant association between ADI and both TNT and OS, even after adjusting to age, race, BC subtypes p= 0.004 and p= 0.034 respectively (Table 3).
Conclusion:
Our study in the Western New York region showed that BC pts living in disadvantaged areas had worse survival and shorter TNT despite being more adherent to chemotherapy/anti HER2 therapy. Our study validates prior studies showing that ADI is an important factor impacting BC outcomes. These data will help guide our future efforts to maximize resource allocation towards these disadvantaged areas to improve BC outcomes.
Table 1
Table 2
Table 3
Citation Format: Malak Alharbi, Arya Mariam Roy, Archit Patel, Kayla Catalfamo, Kristopher Attwood, Angela Omilian, Elizabeth Bouchard, Ellis Levine, Tracey O'Connor, Amy Early, Shipra Gandhi. Area Deprivation Index (ADI) among Patients with Breast Cancer in Buffalo [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-09-06.