Abstract A096: Social determinants of health and patient engagement in cancer care: Insights from a community health worker program on Chicago’s South side

Abstract This study explores how Social Determinants of Health (SDOH) at the ZIP code level influence patient engagement within a Community Health Worker (CHW) program supporting cancer patients on Chicago’s South Side. Disparities in cancer care access persist, disproportionately affecting underserved populations due to barriers like poverty, low education, and transportation. CHWs help address these challenges, but little is known about how neighborhood-level SDOH shape CHW-patient engagement. We conducted a retrospective analysis of 72 cancer patients enrolled in the UChicago Medicine LinC program (Jan 2022–Dec 2023). Inclusion criteria focused on patients engaged under the Cancer service line; those still active, deceased, or enrolled multiple times were excluded. Engagement was defined as at least one home visit or extensive encounter history. The sample was predominantly Black (97%), with a median age of 59.1; 76% were female and 87.5% received outpatient care. Most had Medicare (43.1%) or Medicaid (27.8%). Common primary cancer types included breast (31%), gastrointestinal (25%), and lung (13%). ZIP–level SDOH variables, including poverty rate, educational attainment, minority status, and population aged 65 and older, were obtained from 2024 U.S. Census estimates and linked to patient residential ZIP codes. Driving travel time to the nearest UChicago Medicine cancer care site was calculated using the Google Maps API (patient ZIP centroids). Geospatial mapping was used to overlay patient ZIP codes with travel time, SDOH indicators, and cancer care site locations. Pearson correlations and multiple linear regression models were used to assess predictors of patient engagement. Higher poverty rates were significantly associated with increased patient engagement (β = 0.155, p < 0.001), while lower educational attainment (β = -0.352, p < 0.001) and higher proportions of older adults (β = -0.341, p = 0.002) were linked to reduced engagement. ZIPs with higher minority populations showed increased participation (β = 0.139, p = 0.005), reflecting CHW outreach effectiveness. Travel time was not a significant predictor (β = -0.029, p = 0.778), suggesting CHWs may mitigate transportation barriers. The model accounted for 78% of the variance in patient counts (R2 = 0.782, F = 22.91, p < 0.0001). Limitations include a small sample size (n = 72), which may limit generalizability, and unmeasured confounders such as health literacy and comorbidities, which could independently influence patient engagement and obscure the effects of SDOH factors. Selection bias may also be present, as CHW-engaged patients may differ systematically from those who do not engage. CHWs play a pivotal role in engaging cancer patients from high-poverty and high-minority areas, highlighting their effectiveness in addressing socioeconomic barriers to care. However, targeted strategies are needed to bolster engagement among areas with higher proportions of older adults and lower educational attainment. These findings inform optimization of CHW interventions to reduce cancer care disparities. Citation Format: Tishiya Carey, Alexis Roach, Elizabeth Hansen. Social determinants of health and patient engagement in cancer care: Insights from a community health worker program on Chicago’s South side [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A096.