How Zip Codes Predict Cancer Outcomes

By Alti Rahman, MHA/MBA, CSSBB

Chief Strategy and Innovation Officer

October 22, 2025 in Patient-centric Care

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 needs to become a critical tool in community oncology sustainability. 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 (ADI)?

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 a 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.

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.

Addressing area deprivation isn’t just a compliance exercise, it’s core to delivering patient-centered, high-quality, sustainable oncology care.

Care Management Becomes Essential
Practices that serve high-ADI populations benefit from robust patient support programs that help patients stay on track and reduce costly complications, such as:
- Principal Care Management (PCM)
- Chronic Care Management (CCM)
- Principal Illness Navigation (PIN)
- Behavioral health and symptom management
Supports Quality Metrics and Value-Based Care
Under models like the Enhancing Oncology Model (EOM) and commercial value-based care arrangements, demonstrating improvements among underserved patients can strengthen quality performance and open access to performance incentives. As the definition of whole person care (WPC) continues to integrate social and medical risk management, the strategic relevance of practices that provide WPC will evolve from a performance differentiation factor to a must have along the innovation curve.
Improved ADI Payer Negotiations
Payers increasingly expect data-driven justifications for care complexity and resource use. When used effectively, ADI becomes a negotiating tool for better reimbursement without sacrificing care quality because ADI data supports:
- Higher care-management fees
- Risk-adjusted payment rates
- Flexibility in value-based targets
Framing care through an ADI lens reinforces the value of community-based models that go beyond treatment to address the root causes of disparities.
Strategic Growth and Resource Allocation
AON uses ADI to guide targeted investments, especially in high-need areas where partnerships with employers or health systems could drive expansion. Practices can also use ADI data to inform internal planning, whether adding navigators, expanding behavioral health, or adjusting provider schedules.

A Win–Win for Patients and Practices

As we work toward better cancer care in every zip code, the ADI offers a powerful framework for aligning patient needs with practice growth. It helps identify who needs more support, justifies that support to payers, and ultimately delivers care that’s both more equitable and more effective.

A patient’s address is more than a point on a map it’s a predictor of their cancer journey. The ADI allows us to act on that knowledge with empathy, precision and strategy. That’s why AON continues to invest in high-need communities and expand partnerships that bring cancer care to where patients live and work. More than anything, we succeed by ensuring that where a person lives does not determine whether they live.

If you’re a patient, talk with your care team about how your practice supports social needs that may affect your treatment. If you’re a physician or practice leader exploring how to make ADI work for your oncology practice, download our free white paper, “Surviving to Thriving: A network selection guide for advancing your independent community oncology practice,” and complete the form to connect with an AON business development specialist.

What AON Is Doing

AON has integrated ADI into its national strategy. By incorporating ADI across departments from clinical care to finance, AON supports its network in creating equitable, data-informed oncology care. Efforts include:

Embedding ADI into payer contract modeling.
Using ADI in rate negotiations and access advocacy.
Layering ADI insights into EOM, Turquoise Health, and other value-based care strategies.
Benchmarking practice performance based on ADI.