Higher Composite Social Determinants of Health Scores Are Associated With Worse Survival in Patients With Small Bowel Neuroendocrine Tumors

Background Patients with early‐stage well‐differentiated small bowel neuroendocrine tumors (sbNETs) experience favorable prognosis with timely diagnosis and treatment. However, the impact of social determinants of health (SDH) and care at Minority‐Serving Hospitals (MSHs) on outcomes remains understudied. This study evaluates the combined influence of SDH and hospital type on long‐term survival in sbNETs. Methods The 2010–2020 National Cancer Database was queried for adults with G1/G2 sbNETs, Stage I/II disease, who underwent surgical resection. Patients with G3 NETs, Stage III/IV disease, neuroendocrine carcinoma, duodenal primary tumors, or incomplete follow‐up were excluded. A composite SDH score was developed using four sociogeographic factors: (1) low income, (2) low education, (3) rurality, (4) travel distance > 250 miles. Patients were categorized as SDH+ (score 0–1) or SDH– burden (score 2–4). Hospitals in the top decile for Black and Hispanic representation were classified as MSHs. Kaplan‐Meier and Cox regression analyses were performed. Results Among 2688 patients (median age 64; 48% female), 57% were SDH–. Five‐, 10‐, and 15‐year survival rates were 79%, 62%, and 49%, respectively. At MSHs, 5‐year survival was 82% for SDH+ versus 63% for SDH–. At non‐MSHs, survival was 82% for SDH+ versus 77% for SDH–. Median survival for SDH– patients was 11 years at MSHs versus 12 at non‐MSHs. In regression analysis, SDH– status was linked to worse survival (HR 1.24, p < 0.001); treatment at non‐MSHs predicted better survival (HR 0.41, p < 0.001). Black patients had higher mortality risk (HR 1.20, p = 0.002); no difference was observed for Hispanic patients. Conclusion Higher SDH burden and treatment at MSHs were associated with decreased survival in early‐stage sbNETs. Implementing a composite SDH score in clinical practice may provide a practical tool for risk stratification and guide equity‐focused interventions for patients with sbNETs.