Novel patient-level social determinants of health measure predicts colon cancer outcomes within an integrated health network.

BACKGROUND

Traditional social determinants of health measures rely on population-level data, limiting the ability to assess individual patient-level factors. This study explores the influence of a novel, patient-level social determinants of health measure on oncologic outcomes in patients with colon cancer.

METHODS

Using a program developed within our integrated health network, which prospectively captures 13 specific patient-level social determinants of health components, we categorized patients as high-risk social determinants of health if they reported significant impairments in any social determinants of health domain. We evaluated the independent effect of high-risk social determinants of health on oncologic outcomes among patients with adenocarcinoma of the colon from 2020 to 2023.

RESULTS

Among 717 patients, the mean age was 67.9 ± 13.6 years, with 54.7% (n = 392) male and 90.8% (n = 651) White; 16.2% had a Charlson Comorbidity Index >2 and 21.3% (n = 128) had stage IV disease at diagnosis. Median overall survival for the cohort was 50.0 (28.0-55.0) months. Overall, 24.0% (n = 172) of patients presented with high-risk social determinants of health. Patients in the 2 cohorts were similar in sex, race, and Charlson Comorbidity Index (P > .050). On multivariable analysis, high-risk social determinants of health was an independent predictor of stage IV disease at diagnosis (odds ratio, 2.32; 95% confidence interval, 1.45-3.73; P < .001) and mortality among all patients (hazard ratio, 1.81; 95% confidence interval, 1.16-2.85; P = .010). Among early stage patients (stage I-II), high-risk social determinants of health was an independent predictor of mortality (hazard ratio, 4.61; 95% confidence interval, 1.67-12.69; P = .003).

CONCLUSION

Utilizing a novel prospective measure, patient-level social determinants of health independently predicts metastatic disease at diagnosis as well as stage-specific survival in colon cancer. This presents an opportunity to identify specific cancer patients at high risk for poor oncologic outcomes who may benefit from directed care measures.