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The Use of Area-Level Socioeconomic Indices in Evaluating Cancer Care Delivery: A Scoping Review

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Multiple composite indices of small-area socioeconomic characteristics have been used to examine how neighborhood characteristics influence cancer care, but there is little consensus regarding how to use them. This scoping review aimed to summarize the use of these indices in cancer literature and their association with outcomes.

Methods

A search was conducted to identify studies from 2015 to 2021 that investigated cancer incidence, disease stage at diagnosis, and mortality using area-based indices of deprivation as an independent variable. Studies were screened and assessed for eligibility. Data were extracted regarding the geospatial and statistical use of these indices.

Results

All the inclusion criteria were met by 45 studies. The area level of analysis was at the census tract level in 19 studies (42.3%), the county level in 15 studies (33.3%), the block group level in 6 studies (13.3%), and the ZIP code level in 5 studies (11.1%). Altogether, 18 unique indices were used, with 4 indices used most frequently. Of the studies that used their indices ordinally, 3 defined high and low deprivation dichotomously, 10 used tertiles, 13 used quartiles, and 15 used quintiles. Of the 45 studies, 34 (76%) showed a significant association between area deprivation and cancer-related outcomes.

Conclusions

Neighborhood deprivation indices are most commonly used at the census tract level and ordinally as quintiles. Despite variance in methods, there is a strong indication that deprived areas are at adverse odds with cancer-related outcomes. Further study investigating deprivation in the context of cancer can inform drivers of inequity and identify potential targets for care delivery and policy interventions.

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Authors and Affiliations

  1. The Geisel School of Medicine at Dartmouth, Hanover, NH, USA

    Chad Markey BA, Oluwaferanmi Bello BS, Meg Hanley BA & Andrew P. Loehrer MD, MPH

  2. Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Andrew P. Loehrer MD, MPH

  3. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA

    Andrew P. Loehrer MD, MPH

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  1. Chad Markey BA
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  2. Oluwaferanmi Bello BS
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Markey, C., Bello, O., Hanley, M. et al. The Use of Area-Level Socioeconomic Indices in Evaluating Cancer Care Delivery: A Scoping Review. Ann Surg Oncol 30, 2620–2628 (2023). https://doi.org/10.1245/s10434-023-13099-x

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