Social Determinants of Health Impact on Survival of Patients With Malignant Pleural Mesothelioma.

Background: Patients with malignant pleural mesothelioma (MPM) have a high mortality risk, even after optimal management and accounting for differences in comorbidities. We aimed to assess the overall survival of patients with operable MPM based on social determinants of health (SDH). We hypothesized that an SDH score can predict patients with poorer overall survival despite optimal management.

Methods: This study used a retrospective analysis of the National Cancer Database from 2004 to 2017. Adult patients with clinical stage I-IIIA MPM were included. Based on patients' personal and geographic characteristics, we constructed an SDH score index that identifies patients of socioeconomic disadvantage by the following variables: income, education, geography, and hospital types within 250 miles. We performed a survival analysis using the Kaplan-Meier method as well as univariable and multivariable Cox regression models.

Results: Higher composite SDH scores demonstrated worse outcomes. Overall increased disadvantage increased the risk of mortality by 21% (hazard ratio [HR], 1.21; CI, 1.12-1.30), with a higher increase of 57% for score ≥2 (HR,1.57; CI, 1.36-1.81). After accounting for age, stage, comorbidities, multimodal therapy, and hospital volume and type, the SDH score index remained statistically significant, with a 29% increased risk of mortality for score ≥2 compared with ≤1 (HR, 1.29; CI, 1.10-1.50). Curative surgery with chemotherapy reduced mortality risk by 29% (HR, 0.71; CI, 0.62-0.81) after adjustment for patients' SDH scores and other relevant factors.

Conclusions: Various SDH factors affect survival outcomes independently of treatment modality and patient characteristics. This SDH composite score could help identify patients with socioeconomic disadvantages at risk for suboptimal survival outcomes.