Social vulnerability index as an independent poor prognostic factor in patients with chronic hematological malignancies in Arkansas.

Abstract

e13526 Background: Recent therapeutic advances have significantly improved outcomes in many chronic hematological malignancies (CHMs). However, these novel therapies are expensive and are primarily concentrated in large academic centers, leading to inequities in access to healthcare. Community-level socioeconomic factors, including poverty level, access to healthcare, and transportation, directly influence access to these therapies. Arkansas has a predominantly rural population ( > 43%), providing a good setting to examine the impact of these factors on survival. Methods: We obtained de-identified patient data of all patients diagnosed with common CHMs, including multiple myeloma (MM), chronic myeloid leukemia (CML), chronic lymphocytic leukemia (CLL), and follicular lymphoma (FL), in Arkansas between 2000 and 2023 from the Arkansas Department of Health. The social vulnerability index (SVI), obtained from the CDC SVI interactive map based on the patients' residential zip codes and tract-level poverty data published by the American Community Survey were used as indicators of community-level socio-economic vulnerability to assess their impact on survival. Results: A total of 10,241 patients were diagnosed with MM (4,766), CLL (4,011), FL (921), and CML (543) between 2000 and 2023 in Arkansas. 58% were males. 81% identified as White, 16% as Black, 1% as Hispanic, and 1% as other. MM was relatively more common among Black patients (33%). Median age at diagnosis was 69 years (MM: 69 years, CLL: 71 years, FL: 69 years, and CML: 62 years). The mean SVI for the overall cohort was 0.698 ± 0.203. Mean SVI values were 0.710 ± 0.201 for MM, 0.685 ± 0.205 for CLL, 0.691 ± 0.202 for FL, and 0.699 ± 0.208 for CML. The median overall survival (OS) was 71.8 months (95% CI: 69.4-74.2 months). Disease-specific OS was 47.4 months for MM, 91.8 months for CLL, 104.0 months for FL, and 96.6 months for CML. Higher SVI was significantly associated with shorter survival (Spearman’s ρ = -.021, p = .03). Similarly, higher community poverty level was associated with inferior survival (Spearman’s ρ = -.054, p < .01). Notably, the inverse association between SVI and survival was stronger among Black patients (Spearman’s ρ = -.093, p < .01) than among White patients (Spearman’s ρ = .005, p = .68). In contrast, poverty level showed a stronger inverse association with survival among White patients (Spearman’s ρ = -.047, p < .01) than among Black patients (Spearman’s ρ = -.029, p = .24). Conclusions: Community-level socioeconomic vulnerability, as reflected by the SVI and the neighborhood poverty level, is independently associated with inferior survival in patients with CHMs. Given that a substantial proportion of the U.S. population resides in rural areas, SVI may serve as a useful tool to guide resource allocation and develop targeted strategies to reduce disparities and improve cancer outcomes at a population level.