Area Deprivation Index and Survival Outcomes for Patients With Metastatic Solid Tumors Treated With Immune Checkpoint Inhibitors in the United States

Due to increasing evidence that socioeconomic deprivation influences cancer outcomes through biological effects and care disparities, this single-institution retrospective study estimated associations between neighborhood-level socioeconomic deprivation, measured by the area deprivation index (ADI), and clinical outcomes among patients with metastatic solid tumors treated with immune checkpoint inhibitors (ICIs). Eligible patients included adults with metastatic solid tumors who received ICI between 2013 and 2024 and had a response assessment. Exclusions included adjuvant ICI receipt and missing ADI. Survival outcomes were estimated using the Kaplan-Meier method, and Cox regression models were used to measure associations between ADI and survival in the full cohort and stratified by tumor type. In a cohort of 691 patients with multiple solid tumor types and a median follow-up of 56.1 months, there was a trend toward shorter overall survival (OS) with increasing ADI quartile (HR=1.60 for the most vs. least deprived quartile), although not statistically significant ( P =0.143). There was no significant association between ADI and progression-free survival ( P =0.215). Exploratory analyses of tumor type subsets also revealed no statistically significant association between ADI and OS. In conclusion, there was no significant association between survival and ADI in this cohort. Further study in larger and more diverse cohorts is needed to elucidate the relationship between neighborhood-level socioeconomic deprivation and survival among patients with metastatic solid tumors receiving ICI.