TY - JOUR
T1 - Assessment of Regional Variability in COVID-19 Outcomes among Patients with Cancer in the United States
AU - Hawley, Jessica E.
AU - Sun, Tianyi
AU - Chism, David D.
AU - Duma, Narjust
AU - Fu, Julie C.
AU - Gatson, Na Tosha N.
AU - Mishra, Sanjay
AU - Nguyen, Ryan H.
AU - Reid, Sonya A.
AU - Serrano, Oscar K.
AU - Singh, Sunny R.K.
AU - Venepalli, Neeta K.
AU - Bakouny, Ziad
AU - Bashir, Babar
AU - Bilen, Mehmet A.
AU - Caimi, Paolo F.
AU - Choueiri, Toni K.
AU - Dawsey, Scott J.
AU - Fecher, Leslie A.
AU - Flora, Daniel B.
AU - Friese, Christopher R.
AU - Glover, Michael J.
AU - Gonzalez, Cyndi J.
AU - Goyal, Sharad
AU - Halfdanarson, Thorvardur R.
AU - Hershman, Dawn L.
AU - Khan, Hina
AU - Labaki, Chris
AU - Lewis, Mark A.
AU - McKay, Rana R.
AU - Messing, Ian
AU - Pennell, Nathan A.
AU - Puc, Matthew
AU - Ravindranathan, Deepak
AU - Rhodes, Terence D.
AU - Rivera, Andrea V.
AU - Roller, John
AU - Schwartz, Gary K.
AU - Shah, Sumit A.
AU - Shaya, Justin A.
AU - Streckfuss, Mitrianna
AU - Thompson, Michael A.
AU - Wulff-Burchfield, Elizabeth M.
AU - Xie, Zhuoer
AU - Yu, Peter Paul
AU - Warner, Jeremy L.
AU - Shah, Dimpy P.
AU - French, Benjamin
AU - Hwang, Clara
N1 - Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/1/4
Y1 - 2022/1/4
N2 - 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 250000 (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..
AB - 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 250000 (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..
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U2 - 10.1001/jamanetworkopen.2021.42046
DO - 10.1001/jamanetworkopen.2021.42046
M3 - Article
C2 - 34982158
AN - SCOPUS:85122746299
SN - 2574-3805
VL - 5
JO - JAMA Network Open
JF - JAMA Network Open
IS - 1
M1 - e2142046
ER -