Abstract
Purpose :
Social determinants of health (SDH) continue to gain increasing importance in public health. We evaluate here the significance of a broad variety of SDH in predicting presentation and outcomes of ocular cancer patients.
Methods :
The National Cancer Database was queried for primary clinical tumor (cT) classifications of T1-T4 N0M0 uveal melanoma, conjunctival melanoma, or retinoblastoma diagnosed between January 2006 and December 2017 and treated with curative intent. Pearson Chi squared analysis assessed differences in SDH-related characteristics between cancer cohorts. Binary logistic regression with adjusted odds ratios (aOR) and multivariate Cox proportional hazards ratios (HR) with 95% confidence intervals (CI) were performed.
Results :
3968 uveal melanoma cases, 352 conjunctival melanoma cases, and 480 retinoblastoma cases were included in the analysis. Median ages of presentation for melanomas were greater than 60 years while for retinoblastoma the median age was 1 year old. Significant differences were observed between cancers in the distribution of race, primary payer status, income quartile, population density, facility location, Charlson-Deyo comorbidity score, history of prior malignancy, cT classification at presentation, surgical treatment, surgical margins, radiotherapy, chemotherapy, 30-day surgical readmission, and overall mortality. Female sex (aOR=0.819, 95% CI=0.689–0.973) and top income quartile (aOR=0.691, 95% CI=0.525–0.908) were significantly associated with decreased likelihood of advanced cT classification at presentation while an increased likelihood was observed with no insurance (aOR=1.736, 95% CI=1.159–2.601) and Medicaid primary payer status (aOR=1.875, 95% CI=1.323–2.656) relative to privately insured patients. Rural areas (aOR=7.157, 95% CI=1.875–27.320) relative to metropolitan areas were significantly more likely to be readmitted following initial surgery within 30 days. Increased age was the only SDH significantly associated with increased odds of mortality (HR=1.040, 95% CI=1.033–1.047).
Conclusions :
Our results suggest SDH plays an unrecognized, but critical role with influencing advanced cT classification at presentation and 30-day readmission compared to mortality in ocular cancer patients. Public health efforts should consider targeting mitigation of disparities in SDH.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.