Social vulnerability and survival in 112 000 adolescents and young adults with cancer: a population-based study

Abstract

Evidence suggests neighborhood-level factors contribute to cancer outcomes, although most research focuses on pediatric and adult populations. Using population-based data from the Texas Cancer Registry, we examined neighborhood-level social vulnerability, a composite measure of 14 census tract-level social risk factors, and survival among 112 142 adolescents and young adults with cancer (AYAs, age 15-39 years). We estimated 1-, 5-, and 10-year overall survival by quintile of social vulnerability and used Cox proportional hazards models (2-sided significance testing) to estimate the association between social vulnerability and all-cause mortality. Survival decreased as social vulnerability increased; for example, 5-year survival was 86.5% (95% confidence interval [CI] ¼ 85.1 to 87.0) in the least vulnerable quintile compared to 74.0% (95% CI ¼ 73.4 to 74.5) in the most vulnerable quintile. Social vulnerability was associated with all-cause mortality in adjusted models (highest vs lowest quintile: adjusted hazard ratio [aHR] ¼ 1.55, 95% CI ¼ 1.48 to 1.63). Achieving equity in AYAs’ survival requires interventions to address neighborhood disparities.