The impact of high-risk zip code on receiving standard of care therapy and survival in esophageal adenocarcinoma.

Background: The impact of sociodemographic disparities on oncologic outcomes has been established. The opportunity to investigate high-risk zip codes of residence as related to standard-of-care therapy and subsequent survival offers an avenue to mitigate disparities in esophageal cancer. We aim to evaluate the impact of zip code of residence on survival in those with esophageal adenocarcinoma (EAC). Methods: The National Cancer Database (NCDB) (2012-2021) was utilized to identify patients with non-metastatic EAC who received trimodal therapy. A "high-risk" zip code group was defined as those living in a zip code where >10.9% did not have a high school diploma or the median household income was <$50,353. Results: Of 10,520 patients, 25.01% resided in a high-risk zip code and 89.33% (n=9,398) received standard-of-care trimodal therapy. High-risk zip code was independently associated with reduced odds of receiving trimodal therapy [odds ratio (OR) 0.764, 95% confidence interval (CI): 0.59-0.99, P=0.047] and persisted as an independent negative prognostic factor for survival [hazard ratio (HR) 1.189, 95% CI: 1.09-1.29, P=0.001] in those that received CROSS-concordant therapy. A reduction in median survival was observed in the high-risk zip code group (38.41 months, 95% CI: 35.98-43.24) compared to the low-risk zip code group (44.65 months, 95% CI: 42.15-47.15). Similarly, 5-year overall survival (OS) was reduced in the high-risk group at 39.12% versus 43.31% in the low-risk group (P=0.001). Conclusions: A less affluent and educated zip code of residence is associated with a significant reduction in odds of receiving standard-of-care treatment in EAC. In those receiving trimodal therapy, zip code is a negative prognosticator with associated survival reductions. Identification of at-risk patients and interventions to mitigate such disparities is warranted.