Assessment of Regional Variability in COVID-19 Outcomes Among Patients With Cancer in the United States.
JAMA Netw Open
oregon; chiles; portland; covid-19; Aged; COVID-19; Cause of Death; Censuses; Female; Health Facilities; Humans; Intensive Care Units; Male; Middle Aged; Neoplasms; Odds Ratio; Pandemics; Registries; Respiration, Artificial; Retrospective Studies; Risk Factors; Rural Population; SARS-CoV-2; Severity of Illness Index; Social Vulnerability; Spatial Analysis; United States; Urban Population
Importance: The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography.
Objective: To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer.
Design, Setting, and Participants: This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States.
Exposures: Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index.
Main Outcomes and Measures: The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time.
Results: Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58).
Conclusions and Relevance: In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.
Hawley, Jessica E; Sun, Tianyi; Chism, David D; Duma, Narjust; Fu, Julie C; Gatson, Na Tosha N; Mishra, Sanjay; Nguyen, Ryan H; Reid, Sonya A; Serrano, Oscar K; Singh, Sunny R K; Venepalli, Neeta K; Bakouny, Ziad; Bashir, Babar; Bilen, Mehmet A; Caimi, Paolo F; Choueiri, Toni K; Dawsey, Scott J; Fecher, Leslie A; Flora, Daniel B; Friese, Christopher R; Glover, Michael J; Gonzalez, Cyndi J; Goyal, Sharad; Halfdanarson, Thorvardur R; Hershman, Dawn L; Khan, Hina; Labaki, Chris; Lewis, Mark A; McKay, Rana R; Messing, Ian; Pennell, Nathan A; Puc, Matthew; Ravindranathan, Deepak; Rhodes, Terence D; Rivera, Andrea V; Roller, John; Schwartz, Gary K; Shah, Sumit A; Shaya, Justin A; Streckfuss, Mitrianna; Thompson, Michael A; Wulff-Burchfield, Elizabeth M; Xie, Zhuoer; Yu, Peter Paul; Warner, Jeremy L; Shah, Dimpy P; French, Benjamin; Hwang, Clara; COVID-19 and Cancer Consortium (CCC19); and Kennecke (COVID-19 and Cancer Consortium (CCC19)), Hagen F, "Assessment of Regional Variability in COVID-19 Outcomes Among Patients With Cancer in the United States." (2022). Articles, Abstracts, and Reports. 5795.