Where you live matters: Unpacking the geography of deprivation in oncology care.

234 Background: Geographic and socioeconomic factors significantly influence health outcomes. The Rural-Urban Commuting Area (RUCA) codes classify U.S. census tracts by urbanization and commuting patterns. The Area Deprivation Index (ADI) measures neighborhood disadvantage based on income, education, employment, and housing. Dual eligibility for Medicare and Medicaid, along with low-income subsidy (LIS) status, indicates socioeconomic vulnerability. This study examined correlations among RUCA, ADI, and dual eligibility/LIS in patients with a cancer diagnosis receiving systemic anti-cancer therapies (SACT). Methods: We performed a retrospective, cross-sectional analysis using 6-month episodic claims data from ~2,000 patients with a cancer diagnosis with primary Medicare coverage treated with SACT across a large, multi-state, community oncology network (July 2023–June 2024). RUCA was classified as urban (1–3) or rural (4–10); ADI state rank scores were grouped into low (1–3), medium (4–6), and high (7–10) deprivation; and patients were categorized by dual eligibility/LIS status. Results: Dual eligibility/LIS: Dual eligible = 7%, LIS = 5.2%, non-dual/LIS = 87.8% RUCA: Rural = 28.4%, Urban = 71.6% ADI: High = 33.8%, Medium = 28.2%, Low = 36.1%, Unknown = 1.9% Rural patients were more likely to be dual eligible (10.2% vs. 5.8%) and live in high-deprivation areas (57.4% vs. 24.5%) compared to urban patients. High ADI was associated with greater dual eligibility (11.1%) and LIS use (8.9%) than low ADI (4% and 2.9%, respectively). However, dual eligibility alone was not a consistent indicator of deprivation. Patients in rural, high-deprivation areas had significantly higher hospitalization and emergency department visit rates (15.7% vs. 12.9%, p < 0.0005) than those in urban, low-deprivation areas. Medium-deprivation patients showed more variable patterns. Conclusions: Rurality and neighborhood deprivation jointly shape healthcare access and utilization in oncology. Rural patients were more likely to live in deprived areas and require dual eligibility/LIS support, reflecting compounded structural disadvantage. However, dual eligibility alone did not reliably indicate deprivation. These findings highlight the need to integrate both RUCA and ADI in health equity research and to design targeted interventions addressing geographic and socioeconomic barriers to cancer care. Future studies should explore the domains of deprivation, such as financial toxicity and other individual social deprivation factors in the context of cancer care.