Higher Composite Social Determinants of Health Scores Are Associated With Worse Survival in Patients With Small Bowel Neuroendocrine Tumors.

BACKGROUND: Patients with early-stage well-differentiated small bowel neuroendocrine tumors (sbNETs) experience favorable prognosis with timely diagnosis and treatment. However, the impact of social determinants of health (SDH) and care at Minority-Serving Hospitals (MSHs) on outcomes remains understudied. This study evaluates the combined influence of SDH and hospital type on long-term survival in sbNETs. METHODS: The 2010-2020 National Cancer Database was queried for adults with G1/G2 sbNETs, Stage I/II disease, who underwent surgical resection. Patients with G3 NETs, Stage III/IV disease, neuroendocrine carcinoma, duodenal primary tumors, or incomplete follow-up were excluded. A composite SDH score was developed using four sociogeographic factors: (1) low income, (2) low education, (3) rurality, (4) travel distance > 250 miles. Patients were categorized as SDH+ (score 0-1) or SDH- burden (score 2-4). Hospitals in the top decile for Black and Hispanic representation were classified as MSHs. Kaplan-Meier and Cox regression analyses were performed. RESULTS: Among 2688 patients (median age 64; 48% female), 57% were SDH-. Five-, 10-, and 15-year survival rates were 79%, 62%, and 49%, respectively. At MSHs, 5-year survival was 82% for SDH+ versus 63% for SDH-. At non-MSHs, survival was 82% for SDH+ versus 77% for SDH-. Median survival for SDH- patients was 11 years at MSHs versus 12 at non-MSHs. In regression analysis, SDH- status was linked to worse survival (HR 1.24, p < 0.001); treatment at non-MSHs predicted better survival (HR 0.41, p < 0.001). Black patients had higher mortality risk (HR 1.20, p = 0.002); no difference was observed for Hispanic patients. CONCLUSION: Higher SDH burden and treatment at MSHs were associated with decreased survival in early-stage sbNETs. Implementing a composite SDH score in clinical practice may provide a practical tool for risk stratification and guide equity-focused interventions for patients with sbNETs.