Impact of Zip-Based Social Determinants on Textbook Outcomes and Survival of Resected Early-Stage NSCLC

This study investigates the impact of ZIP-code-based social determinants of health (SDH) on textbook oncological outcomes (TOO) and overall survival (OS) in patients with surgically resected clinical stage IA/B non-small-cell lung cancer (NSCLC).

We queried the National Cancer Database (2010-2020) to identify sociogeographic status through SDH scores, which are based on low income, education levels, rurality, and hospital type (disadvantage: SDH- score 2-4; advantage: SDH + score 0-1). TOO achievement (TOO+) was defined as R0 resection, ≥ 5 lymph nodes harvested, appropriate adjuvant chemotherapy, no 90-day mortality, prolonged hospital stays, and unplanned readmission. Logistic and Cox regression analyses assessed the impact of SDH on TOO + and OS.

Of 131,134 patients meeting inclusion criteria, 48.8% were TOO + and 30.3% were SDH + . A higher incidence of TOO + was observed in SDH + cohort (P < .001). SDH- patients were 14% less likely to be TOO + and had a significantly worse median OS (8.4 years) compared to SDH + patients (11 years), regardless of TOO status. TOO + correlated with a 2.6-year increase in median OS vs. that of TOO- cohort. The best median OS was observed in SDH+/TOO + patients (12 years) vs. that of SDH-/TOO- patients (7 years). TOO + mitigated the negative impact of SDH- on OS. After adjusting for confounders, SDH- was associated with a 21% higher mortality risk and TOO + independently reduced mortality by 34%.

SDH significantly influences TOO and OS in the NSCLC patient population. The negative impact of SDH- on OS was mitigated by TOO + . SDH+/TOO + patients had the best OS.