Association of Socioeconomic Disadvantage with Lower Patient Satisfaction at an Academic Radiation Oncology Center

Document Type

Conference Proceeding

Publication Date


Publication Title

JCO Oncology Practice


Background: The correlation between socioeconomic status and healthcare outcomes is well-established. Patient satisfaction serves as a crucial indicator of healthcare quality, however, it is unclear if patient satisfaction relates to patient socioeconomic status. To assess socioeconomic status, the Area Deprivation Index (ADI) is utilized, encompassing factors such as income, education, employment, and housing quality to measure the status of a neighborhood. The purpose of this study was to evaluate if there was a correlation between socioeconomic status and the likelihood a patient would recommend the facility or provider. Methods: This is a single-institution study evaluating the responses to a CMS approved patient satisfaction vendor survey of patients seen at an outpatient academic radiation oncology department from May 2021 through March 2023. ADI was collected using the Neighborhood Atlas, including both national percentiles and state deciles, with the higher values indicating greater socioeconomic disadvantage. Univariate (UVA) and multivariate (MVA) logistic regression analyses were conducted using the survey recommendation scores between 0 and 10 as the primary outcome. We used the score ≥9 to represent increased likelihood for recommendation for facility or provider and <9 represented decreased likelihood. Results: There were 5,403 survey results included in our analysis. The mean state and national ADI in our cohort were 3.9 (range 1-10) and 50.35, respectively. Patients with state and national ADI scores below the mean were more likely to recommend the provider than those above the mean, 95.6% versus 93.6% (p=0.002) and 95.8% versus 93.6% (p<0.001), respectively. There was no difference in the likelihood of recommending the facility between the groups. On univariate analysis state ADI <3.9 (OR 1.46, p=0.016) and national ADI <50.35 (OR 1.43, p=0.023) were associated with increased likelihood to recommend the facility or provider. On multivariate analysis, state ADI <3.9 (OR 1.44, p=0.018) and national ADI <50.35 (OR 1.40, p=0.033) remained significant. Conclusions: The findings of this study highlight the significance of socioeconomic status as an independent factor influencing patient satisfaction and their likelihood to recommend a healthcare provider. Providers should consider the unique needs of socioeconomically disadvantaged individuals.




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American Society of Clinical Oncology ASCO Quality Care Symposium, October 27-28, 2023, Boston, MA