Neighborhood deprivation on increasing deficit accumulation in older breast cancer survivors and non-cancer controls

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BACKGROUND: Neighborhood characteristics can affect aging and health. We tested effects of neighborhood deprivation on deficit accumulation frailty scores in a prospective cohort of breast cancer survivors vs. controls aged 60-98. METHODS: Newly diagnosed, non-metastatic breast cancer survivors (477) and frequency-matched controls (434) were enrolled from 2010-2023, with up to 5-year follow-up through 2024. Deficit accumulation was measured with a 48-item index (scores 0-1); a clinically meaningful deficit increase was defined by a 0.06 score increase. Neighborhood deprivation was assessed using area deprivation index (ADI) at enrollment census block group and categorized into tertiles. Cause-specific Cox models tested the association between ADI and risk of deficit accumulation increase. RESULTS: Participants living in more deprived areas (2nd and 3rd tertiles of ADI) had higher risks of increased deficit accumulation (adjusted hazard ratios [aHR] 1.38 [1.01-1.89; P = .04] and 1.46 [1.07-1.94; P = .01] vs. 1st tertile, respectively). Independent of ADI, being a survivor (vs. control) was associated with greater risk of increased deficit accumulation (aHR = 1.69 [1.32-2.17, P<.001]). There were different patterns of cumulative incidence rates of increased deficit accumulation by ADI survivors treated with chemotherapy (+/- hormonal therapy) living in more vs. less deprived areas had a 20% higher incidence of increased deficit accumulation within 1 year (P = .004), while survivors receiving hormonal therapy alone and non-cancer controls had their most pronounced differences by 4 years (10%; P = .32 and 10%; P = .05, respectively). CONCLUSIONS: Neighborhood deprivation may increase deficit accumulation, with an apparent acceleration of effects among older breast cancer survivors treated with chemotherapy.

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