Impact of the Area Deprivation Index on stage at diagnosis in penile squamous cell carcinoma: A statewide cohort analysis

Background: Penile cancer is a rare malignancy influenced by socioeconomic factors. The Area Deprivation Index (ADI) is a validated measure of neighborhood-level socioeconomic disadvantage, and its association with penile cancer stage at presentation has not been studied. This study aimed to assess the relationship between the ADI and advanced-stage disease at diagnosis in penile cancer. Methods: A retrospective study was conducted with the Michigan Department of Health and Human Services database of patients aged ≥18 years with penile squamous cell carcinoma from 2004 to 2019. Advanced-stage disease was defined as pathological T stage ≥2, pathological evidence of nodal metastasis, or reported presence of distal metastasis. ADI scores were compared to the national median value. Univariable and multivariable logistic regression analyses were performed to assess the association between the ADI and advanced disease after adjusting for relevant covariates. Results: Among 353 patients (median age, 72 years; 84.4% White), the median ADI score was 69. Patients were stratified into two groups on the basis of the national median; 76% were in the high-ADI group. Black patients were more prevalent in the higher ADI group (15.3% vs. 2.4%; p =.003). Advanced-stage penile cancer was more frequent in the higher ADI group (49.3% vs. 36.5%; p =.04). In multivariable analysis, each 10-point increase in the ADI was associated with 1.16-fold increased odds of advanced-stage disease (95% CI, 1.04–1.29; p =.02). Conclusions: Greater neighborhood-level socioeconomic deprivation is associated with advanced-stage disease at penile cancer diagnosis. These findings emphasize the role of social determinants in disease presentation, and may guide targeted interventions in disadvantaged populations.