Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., MC 923, Chicago, IL, 60612, USA.
Center for Research on Women and Gender, University of Illinois at Chicago, Rm 536A, 1640 W. Roosevelt Rd., MC 980, Chicago, IL, 60608, USA.
Support Care Cancer. 2021 Jan;29(1):331-340. doi: 10.1007/s00520-020-05497-8. Epub 2020 May 2.
Rural women, compared to urban, experience worse survivorship outcomes, including poorer health-related quality of life (QOL). There is a need to characterize the role of multilevel social factors that contribute to QOL, including context, networks, and functioning. Our objectives were to (1) use latent class analysis to identify distinct classes of social context and social networks and (2) examine how multilevel social factors (context, networks, and functioning) are associated with health-related QOL.
We recruited self-identified rural survivors to the Illinois Rural Cancer Assessment (2017-2018), via community-based sampling methods, and participants completed the survey online, by phone, or on paper. We used latent class analysis to generate multidimensional variables for contextual and network factors. We next modeled each social factor sas a predictor in separate, bivariable linear regressions for the QOL outcomes, followed by multivariable, adjusted regressions.
For our first objective, there were three classes each of county-level contexts (1, highly rural, socioeconomically disadvantaged, and mostly lacking in cancer-related services; 2, mostly rural, moderately disadvantaged, and underserved; 3, mostly metropolitan, less disadvantaged, and most-resourced) and social networks (1, no caregivers; 2, only spousal caregivers with whom they communicated daily; 3, multiple caregivers with varying daily communication). For our second objective, among all social factors, only functioning was associated with better mental health-related QOL. No factors were associated with physical health-related QOL.
Our findings suggest a rich diversity of social context and networks among rural female cancer survivors, and social functioning is particularly important for mental health-related QOL.
与城市女性相比，农村女性的生存结果更差，包括生活质量相关的健康状况更差。需要描述有助于生活质量的多层次社会因素的作用，包括背景、网络和功能。我们的目的是：（1）使用潜在类别分析来确定不同的社会背景和社会网络类别；（2）研究多层次社会因素（背景、网络和功能）与生活质量相关的关系。
我们通过社区抽样方法，从伊利诺伊州农村癌症评估（2017-2018 年）中招募了自我认同的农村幸存者，参与者通过在线、电话或纸质方式完成了调查。我们使用潜在类别分析为背景和网络因素生成多维变量。接下来，我们分别使用多元线性回归对每个社会因素进行了模型构建，将其作为生活质量结果的预测因子，然后进行了多变量调整后的回归。
对于我们的第一个目标，每个县一级的环境（1、高度农村、社会经济劣势、癌症相关服务主要缺乏；2、主要农村、中等劣势、服务不足；3、主要大都市区、劣势较少、资源最多）和社会网络（1、没有照顾者；2、只有配偶照顾者，他们每天交流；3、有多个照顾者，每天交流程度不同）都有三个类别。对于我们的第二个目标，在所有社会因素中，只有功能与心理健康相关的生活质量更好相关。没有因素与身体健康相关的生活质量相关。
我们的研究结果表明，农村女性癌症幸存者的社会背景和网络存在着丰富的多样性，社会功能对心理健康相关的生活质量尤为重要。
