Area Deprivation and Clinical Biomarkers of Inflammation in Cancer Survivors of the National Institutes of Health All of Us Research Program

Background: High neighborhood deprivation is linked to increased cancer and overall mortality. Prior studies demonstrated higher inflammation in people from high deprivation areas. The area deprivation index (ADI) is a composite measure of income, education, employment, and housing, which quantifies neighborhood deprivation. We used the All of Us dataset to test whether inflammation, measured via c-reactive protein (CRP), albumin, and the neutrophil-to-lymphocyte ratio (NLR), differs by ADI in cancer survivors. Methods: Our sample included individuals with a history of lung, breast, prostate, and colorectal cancer, filtered for the presence of the inflammatory biomarkers. We used quartiles of ADI based on 3-digit zip code and biomarkers from electronic health records. We estimated the association between ADI and inflammation using adjusted logistic regression (n = 690 for CRP; n = 4242 for albumin; n = 5183 for NLR). Results: The sample had a mean age of 66.2 +/- 10.1 years, 63.0% were female, and 86.8% were White. Mean CRP (11.5 +/- 17.5 mg/L) and NLR (3.6 +/- 2.2) indicated moderate to high inflammation. In the fully adjusted model, there were 2.04 (95% CI:1.02, 4.11) and 2.17 higher odds (95% CI:1.16, 4.13) of elevated CRP when comparing quartile 4 and quartile 3, respectively, to the lowest ADI quartile. Regression models were not significant for albumin or NLR. Conclusion: Area deprivation is associated with CRP, a marker of stress that may lead to a higher risk of chronic diseases among cancer survivors. Future studies using a sample of cancer survivors with a wider range of ADI may help to strengthen this association.