How Zip Codes Predict Cancer Outcomes

The Area Deprivation Index (ADI) and Its Impact on Community-Based Oncology

Imagine two patients begin chemotherapy on the same day. One lives near a grocery store and pharmacy, has safe sidewalks and reliable transportation. The other lives in a neighborhood where food is scarce, pharmacies are distant, and getting to the clinic means multiple bus transfers. Even with identical diagnoses and the same oncologist, these patients are on very different journeys.

This is the reality the Area Deprivation Index (ADI) helps us understand-and why it's becoming a critical tool in community oncology. Access to cancer care close to home is one of the key reasons community oncology is so crucial to improving outcomes. AON practices are uniquely positioned to respond, not only by delivering high-quality care where patients live, but also by partnering with local nonprofits to remove barriers such as transportation and financial hardship. Through programs like the American Oncology Cares foundation, which helps cover essential living expenses such as housing, utilities, transportation, and food, patients and their families gain peace of mind and can focus fully on their health journey.

What Is the Area Deprivation Index?

The ADI is a nationally recognized measurement of socioeconomic disadvantage at the neighborhood level. Developed by researchers at the University of Wisconsin, the ADI assigns scores from 1 (least disadvantaged) to 100 (most disadvantaged) using 17 variables from the U.S. Census. These include factors such as:

• Income level
• Level of education
• Quality of housing
• Employment status

Why ADI Matters to Cancer Outcomes

The ADI has been shown to predict treatment adherence, survival, and care delays across multiple cancer types. In breast cancer, for instance, a 2024 study published in the Journal of Clinical Oncology found that patients in high-ADI areas (≥60) had a significantly lower five-year overall survival rate-73% compared to 84% in low-ADI communities (<60). In another national study published in 2021 in the Journal of the American Medical Association Open Network, researchers found that women residing in the most socioeconomically deprived neighborhoods had a 47% higher mortality rate from breast cancer compared to those in the least deprived areas.

This is not limited to breast cancer. High ADI has also been associated with worse outcomes in head and neck cancers, gastrointestinal malignancies and other common cancer types treated in community settings. In all cases, it's clear that social context shapes clinical outcomes.

Alti Rahman, MHA/MBA, CSSBB, Chief Strategy and Innovation Officer at American Oncology Network (AON), noted, "Socioeconomic factors such as income, level of education, and where a patient lives can predict whether they get timely cancer screenings, how often they miss appointments, and whether they can adhere to treatment plans. These factors can drastically impact patient outcomes."

Clinical Barriers with Real-World Consequences

For community oncology practices, ADI isn't an abstract policy term. It's a window into the barriers patients face every day:

• Transportation challenges that prevent timely treatment.
• Food insecurity that affects nutrition and healing.
• Housing instability that creates stress and disrupts care.
• Limited health literacy that impairs decision-making and adherence.

These social determinants translate into direct clinical and operational challenges: more no-shows, delayed diagnoses, avoidable hospitalizations, and higher acuity upon presentation. Through programs like American Oncology Cares, AON's non-profit, practices can help address these challenges by offering transportation support, access to food resources, and community health navigation.

Why Practices Need to Pay Attention

Recognizing high-ADI patients isn't just compassionate. It's critical for optimizing care and ensuring long-term sustainability clinically, financially and strategically.