Table 2.
Hazard Ratios (HRs) and 95% Confidence Intervals (95% CIs) of the Association between Social Determinants of Health, Covariates, and Overall Survival Stratified by Cancer Type.
| Variable | Breast | Prostate | Colorectal | Lung | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Model 1 | Model 2 | Model 3 | Model 4 | Model 1 | Model 2 | Model 3 | Model 4 | Model 1 | Model 2 | Model 3 | Model 4 | Model 1 | Model 2 | Model 3 | Model 4 | |
| SVI Quartile | ||||||||||||||||
| Q1 | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | ||||||||
| Q2 | 1.08 (1.00, 1.17) | 1.04 (0.96, 1.13) | 1.14 (1.03, 1.26) | 1.07 (0.97, 1.18) | 1.11 (1.04, 1.19) | 1.10 (1.03, 1.17) | 1.15 (1.10, 1.20) | 1.13 (1.09, 1.18) | ||||||||
| Q3 | 1.23 (1.13, 1.33) | 1.17 (1.08, 1.27) | 1.30 (1.18, 1.44) | 1.19 (1.08, 1.31) | 1.13 (1.06, 1.21) | 1.10 (1.03, 1.18) | 1.15 (1.10, 1.21) | 1.13 (1.08, 1.18) | ||||||||
| Q4 | 1.23 (1.14, 1.34) | 1.16 (1.07, 1.26) | 1.41 (1.27, 1.56) | 1.24 (1.12, 1.38) | 1.19 (1.12, 1.28) | 1.15 (1.08, 1.23) | 1.08 (1.00, 1.16) | 1.05 (0.98, 1.13) | ||||||||
| Rural-Urban Status | ||||||||||||||||
| Metropolitan | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | ||||||||
| Micropolitan | 0.98 (0.89, 1.07) | 0.91 (0.83, 1.00) | 1.31 (1.19, 1.43) | 1.19 (1.09, 1.31) | 1.06 (1.00, 1.14) | 1.03 (0.96, 1.10) | 1.05 (0.99, 1.11) | 1.03 (0.98, 1.09) | ||||||||
| Small Town | 1.08 (0.97, 1.21) | 1.01 (0.91, 1.13) | 1.28 (1.15, 1.42) | 1.17 (1.05, 1.30) | 1.06 (0.99, 1.14) | 1.01 (0.95, 1.09) | 1.01 (0.96, 1.07) | 0.99 (0.93, 1.04) | ||||||||
| Rural | 1.20 (1.04, 1.37) | 1.09 (0.95, 1.25) | 1.11 (0.91, 1.35) | 1.00 (0.83, 1.21) | 1.07 (0.98, 1.18) | 1.01 (0.91, 1.13) | 1.09 (1.06, 1.14) | 1.08 (1.04, 1.12) | ||||||||
| Insurance Status | ||||||||||||||||
| Private | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | ||||||||
| Medicare | 1.88 (1.72, 2.06) | 1.86 (1.70, 2.04) | 2.36 (2.14, 2.61) | 2.30 (2.08, 2.54) | 1.31 (1.22, 1.41) | 1.30 (1.21, 1.40) | 1.11 (1.06, 1.16) | 1.10 (1.05, 1.16) | ||||||||
| Public (non-Medicare) | 1.82 (1.62, 2.05) | 1.79 (1.59, 2.01) | 1.96 (1.73, 2.22) | 1.92 (1.69, 2.18) | 1.62 (1.47, 1.79) | 1.60 (1.45, 1.76) | 1.28 (1.18, 1.40) | 1.27 (1.17, 1.39) | ||||||||
| Insured, NOS | 1.12 (0.99, 1.26) | 1.11 (0.98, 1.26) | 1.05 (0.90, 1.23) | 1.05 (0.90, 1.22) | 1.08 (0.93, 1.24) | 1.08 (0.94, 1.24) | 1.21 (1.07, 1.37) | 1.20 (1.07, 1.35) | ||||||||
| Uninsured | 2.52 (2.11, 3.02) | 2.47 (2.06, 2.95) | 3.28 (2.74, 3.92) | 3.17 (2.65, 3.80) | 1.56 (1.38, 1.77) | 1.54 (1.36, 1.74) | 1.54 (1.41, 1.69) | 1.53 (1.40, 1.68) | ||||||||
| Age at Diagnosis | 1.14 (1.14, 1.15) | 1.14 (1.14, 1.15) | 1.13 (1.13, 1.14) | 1.13 (1.13, 1.14) | 1.20 (1.20, 1.21) | 1.20 (1.20, 1.21) | 1.19 (1.18, 1.20) | 1.19 (1.18, 1.20) | 1.10 (1.10, 1.11) | 1.10 (1.10, 1.11) | 1.10 (1.10, 1.10) | 1.10 (1.10, 1.10) | 1.07 (1.07, 1.07) | 1.07 (1.07, 1.07) | 1.07 (1.07, 1.07) | 1.07 (1.07, 1.07) |
| Race | ||||||||||||||||
| White | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) |
| Black | 1.06 (0.99, 1.13) | 1.11 (1.04, 1.19) | 1.07 (1.00, 1.14) | 1.02 (0.95, 1.09) | 1.08 (1.01, 1.16) | 1.20 (1.12, 1.28) | 1.10 (1.03, 1.18) | 1.05 (0.98, 1.13) | 1.08 (1.03, 1.14) | 1.13 (1.08, 1.19) | 1.09 (1.04, 1.15) | 1.06 (1.00, 1.11) | 0.99 (0.93, 1.06) | 0.99 (0.94, 1.05) | 0.98 (0.92, 1.03) | 0.99 (0.92, 1.05) |
| Other | 0.46 (0.32, 0.67) | 0.46 (0.31, 0.66) | 0.43 (0.29, 0.63) | 0.43 (0.30, 0.64) | 0.97 (0.71, 1.34) | 1.01 (0.73, 1.39) | 0.96 (0.70, 1.30) | 0.97 (0.71, 1.32) | 0.66 (0.53, 0.83) | 0.66 (0.53, 0.83) | 0.64 (0.50, 0.81) | 0.64 (0.50, 0.81) | 0.89 (0.78, 1.00) | 0.88 (0.77, 1.00) | 0.87 (0.77, 0.99) | 0.88 (0.77, 1.00) |
| Sex | ||||||||||||||||
| Male | NA | NA | NA | NA | NA | NA | NA | NA | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) |
| Female | NA | NA | NA | NA | NA | NA | NA | NA | 0.81 (0.77, 0.84) | 0.81 (0.77, 0.84) | 0.80 (0.77, 0.84) | 0.80 (0.77, 0.84) | 0.91 (0.88, 0.94) | 0.91 (0.88, 0.94) | 0.91 (0.88, 0.94) | 0.91 (0.88, 0.94) |
| Stage at Diagnosis | ||||||||||||||||
| Early | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) |
| Late | 1.96 (1.86, 2.06) | 1.97 (1.87, 2.08) | 1.92 (1.82, 2.02) | 1.92 (1.82, 2.02) | 1.33 (1.24, 1.43) | 1.34 (1.24, 1.44) | 1.34 (1.25, 1.44) | 1.34 (1.24, 1.43) | 1.48 (1.41, 1.55) | 1.48 (1.41, 1.55) | 1.46 (1.40, 1.54) | 1.47 (1.40, 1.54) | 1.32 (1.23, 1.42) | 1.33 (1.23, 1.43) | 1.31 (1.22, 1.40) | 1.31 (1.22, 1.40) |
| Subtype | ||||||||||||||||
| HR+/HER2+ | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | 1.0 (Ref) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| HR+/HER2− | 1.14 (1.03, 1.25) | 1.13 (1.03, 1.24) | 1.14 (1.04, 1.25) | 1.14 (1.04, 1.25) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| HR−/HER2+ | 1.29 (1.13, 1.49) | 1.28 (1.12, 1.47) | 1.32 (1.15, 1.51) | 1.31 (1.14, 1.51) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
| TNBC | 1.50 (1.34, 1.68) | 1.49 (1.33, 1.66) | 1.47 (1.32, 1.64) | 1.47 (1.32, 1.64) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA |
Statistical significance set at α=0.05.
Bold indicates statistical significance.
Model 1: social vulnerability index (SVI) adjusted for covariates: age at diagnosis, race, sex (colorectal and lung cancer), stage at diagnosis, subtype (breast cancer)
Model 2: rural-urban status adjusted for covariates
Model 3: insurance status adjusted for covariates
Model 4: SVI, rural-urban status, insurance status adjusted for covariates
Estimated using Cox proportional hazards regression models with robust standard errors to account for census tract clustering
Abbreviations: HER2, human epidermal growth factor-2; HR, hormone receptor; NA, not applicable; NOS, not otherwise specified; TNBC, triple-negative breast cancer.