388 Subtyping social determinants of health in cancer: Implications for health equity policies

Abstract

Objectives/Goals: Although several studies have identified significant associations between specific social determinants of health (SDoH) and adverse outcomes, little is known about how SDoH co-occur to form subtypes and their outcome-based risks. Here we analyze how SDoH co-occur across all participants with a cancer diagnosis in the All of Us program. Methods/Study Population: Data: All participants (n = 3361) with cancer and their responses to 110 survey questions related to SDoH. Independent variables: 18 SDoH factors aggregated from the questions to address uneven granularity. Dependent variables: depression, delayed medical care, and ER visits in the last year. Analytical Method. (1) Bipartite network analysis with modularity maximization to identify participant-SDoH biclusters, measure the degree of their biclusteredness (Q), and estimate the significance of Q. (2) Visualization of the results using the ExplodeLayout force-directed algorithm. (3) Multivariable logistic regression (adjusted for demographics and corrected through FDR) to measure the odds ratio (OR) of each bicluster compared pairwise with the other biclusters to estimate their risk for the 3 outcomes. Results/Anticipated Results: As shown in Fig. 1A (http://www.skbhavnani.com/DIVA/Images/Cancer-SDoH.jpg), the analysis (n = 3361, d = 18) identified 4 biclusters with significant biclusteredness (Q = 0.13, random-Q = 0.11, z = 9.94, P Discussion/Significance of Impact: Currently, many health equity policies allocate resources based on sociodemographic factors like race and income to address disparities. The 4 distinct subtypes and their outcome-based risks suggest that such policies could be more precise if they were based directly on combinations of need using SDoH subtypes and their risk stratification.