Associations of Social Deprivation and Oncology Physician Network Vulnerability With Acute Care Utilization in the SEER ‐Medicare Population

作者：Ashlee A. Korsberg, Gabriel A. Brooks, A. James O’Malley, Tracy Onega, Andrew Schaefer, Erika L. Moen · 发表于：Health Services Research · 年份：2025 · DOI：10.1111/1475-6773.70070 · 被引用次数：1 · 研究领域：Health disparities and outcomes、Food Security and Health in Diverse Populations、Primary Care and Health Outcomes

OBJECTIVE: The objectives of this study were to evaluate associations of social deprivation with acute care utilization among patients with cancer, and to examine potential effect modification by physician network vulnerability. STUDY SETTING AND DESIGN: For this retrospective cohort study, the primary exposure variable was neighborhood-level socioeconomic disadvantage, operationalized through the social deprivation index (SDI). We assembled physician patient-sharing networks and calculated a measure of network vulnerability for each referral region to capture specialist scarcity. The two outcomes of interest were counts of emergency department (ED) visits and non-elective hospitalizations during the 12 months following cancer diagnosis. We conducted hurdle regressions, with logistic and negative binomial mixed-effects models for the zero and positive, non-zero parts of the outcome distribution, respectively, and stratified by physician network vulnerability. DATA SOURCES AND ANALYTIC SAMPLE: We analyzed 2016-2020 Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data for Medicare beneficiaries diagnosed with breast, colorectal, or lung cancer. PRINCIPAL FINDINGS: The study cohort comprised 47,756 patients with breast, colorectal or lung cancer. Patients in high SDI neighborhoods (vs. low) had a higher probability of at least one ED visit across all physician network vulnerability strata (low network vulnerability-average marginal effect (AME) [95% CI]: 0.03 ...