Abstract 799: Area-level socioeconomic deprivation is associated with inadequate access to quality preoperative care and increased readmission after surgery for early-stage lung cancer

Abstract Objective: Socioeconomic deprivation (SED) has been associated with higher lung cancer risk and mortality. However, the effects of SED on lung cancer outcomes in an integrated, single-payer healthcare system, such as the Veterans Health Administration (VHA), remains unknown. We sought to examine the impact of area-level SED on access to care and outcomes in veterans with early-stage non-small cell lung cancer (NSCLC). Methods: We conducted a retrospective cohort study of patients with clinical stage I NSCLC receiving definitive surgical treatment in the VHA from 2006-2016. Patients were assigned an area deprivation index (ADI) score, a ZIP code-level measure of SED incorporating multiple poverty, education, housing, and employment indicators from the United States Census. Using multivariable analysis, we evaluated the relationship between ADI and guideline-concordant quality metrics (QMs) that stage I NSCLC patients should routinely meet in the preoperative (positron emission tomography PET imaging, smoking cessation support SCS, pulmonary function testing PFT, and timely surgery) and postoperative (cancer surveillance imaging, SCS, and appropriate oncology referral) periods. We also assessed the association between ADI and various cancer-specific outcomes including overall survival (OS). Results: The study included 9, 704 patients. High ADI was associated with lower likelihood of receiving PET imaging (ADI ≥76 vs. ≤50: adjusted odds ratio aOR 0. 592, 95% CI 0. 502-0. 698) and PFT (ADI ≥76 vs. ≤50: aOR 0. 816, 95% CI 0. 694-0. 959) before surgery. High ADI was also associated with delayed surgery (12 weeks after diagnosis; ADI ≥76 vs. ≤50: aOR 1. 202, 95% CI 1. 058-1. 366). ADI was associated with 30-day readmission after surgery (ADI ≥76 vs. ≤50: aOR 1. 380, 95% CI 1. 103-1. 726) but not with 30-day mortality (ADI ≥76 vs. ≤50: aOR 1. 221, 95% CI 0. 816-1. 826), major complications (ADI ≥76 vs. ≤50: aOR 0. 927, 95% CI 0. 780-1. 101), prolonged hospital length of stay (≥14 days; ADI ≥76 vs. ≤50: aOR 0. 893, 95% CI 0. 755-1. 056), or 90-day mortality (ADI ≥76 vs. ≤50: aOR 0. 876, 95% CI 0. 645-1. 190). ADI was not associated with adherence to postoperative QMs (ADI ≥76 vs. ≤50: aOR 0. 888, 95% CI 0. 764-1. 032), OS (ADI ≥76 vs. ≤50: aOR 0. 984, 95% CI 0. 911-1. 062), or cumulative incidence of cancer recurrence (ADI ≥76 vs. ≤50: aOR 1. 047, 95% CI 0. 930-1. 179). Conclusions: Area-level SED is associated with inadequate adherence to preoperative QMs and increased readmission after surgery for stage I NSCLC. Our data suggests that veterans with high SED experience inadequate access to quality preoperative care for early-stage NSCLC but do not have inferior long-term outcomes after resection. Future VHA policies should focus on providing more equitable guideline-concordant preoperative care and preventing postoperative readmission for stage I NSCLC. Citation Format: Steven Tohmasi, Daniel B. Eaton, Brendan T. Heiden, Nikki E. Rossetti, Martin W. Schoen, Su-Hsin Chang, Yan Yan, Mayank R. Patel, Bryan F. Meyers, Benjamin D. Kozower, Varun Puri. Area-level socioeconomic deprivation is associated with inadequate access to quality preoperative care and increased readmission after surgery for early-stage lung cancer abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts) ; 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84 (6Suppl): Abstract nr 799.