Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
University of California, San Diego, San Diego, CA, USA.
Cancer Causes Control. 2024 Feb;35(2):203-214. doi: 10.1007/s10552-023-01782-z. Epub 2023 Sep 7.
We aimed to assess whether nativity differences in socioeconomic (SES) barriers and health literacy were associated with healthcare delays among US cancer survivors.
"All of Us" survey data were analyzed among adult participants ever diagnosed with cancer. A binary measure of healthcare delay (1+ delays versus no delays) was created. Health literacy was assessed using the Brief Health Literacy Screen. A composite measure of SES barriers (education, employment, housing, income, and insurance statuses) was created as 0, 1, 2, or 3+. Multivariable logistic regression model tested the associations of (1) SES barriers and health literacy with healthcare delays, and (2) whether nativity modified this relationship.
Median participant age was 64 years (n = 10,020), with 8% foreign-born and 18% ethnic minorities. Compared to survivors with no SES barriers, those with 3+ had higher likelihood of experiencing healthcare delays (OR 2.18, 95% CI 1.84, 2.58). For every additional barrier, the odds of healthcare delays were greater among foreign-born (1.72, 1.43, 2.08) than US-born (1.27, 1.21, 1.34). For every 1-unit increase in health literacy among US-born, the odds of healthcare delay decreased by 9% (0.91, 0.89, 0.94).
We found that SES barriers to healthcare delays have a greater impact among foreign-born than US-born cancer survivors. Higher health literacy may mitigate healthcare delays among US cancer survivors. Healthcare providers, systems and policymakers should assess and address social determinants of health and promote health literacy as a way to minimize healthcare delays among both foreign- and US-born cancer survivors.
本研究旨在评估美国癌症幸存者中，社会经济地位（SES）障碍和健康素养方面的差异是否与医疗保健延迟相关。
对“All of Us”研究调查数据中曾被诊断患有癌症的成年参与者进行分析。创建了一个医疗保健延迟的二进制指标（1+次延迟与无延迟）。使用简短健康素养筛查量表评估健康素养。SES 障碍的综合衡量指标（教育、就业、住房、收入和保险状况）设定为 0、1、2 或 3+。多变量逻辑回归模型检验了 SES 障碍和健康素养与医疗保健延迟的关联（1），以及（2）出生地点是否改变了这种关系。
参与者的中位年龄为 64 岁（n=10020），8%为外国出生，18%为少数民族。与无 SES 障碍的幸存者相比，有 3+障碍的幸存者更有可能经历医疗保健延迟（OR 2.18，95%CI 1.84，2.58）。每增加一个障碍，外国出生者发生医疗保健延迟的可能性就比美国出生者高（1.72，1.43，2.08），而美国出生者发生医疗保健延迟的可能性就比美国出生者高（1.27，1.21，1.34）。对于每一个健康素养增加 1 单位，美国出生者发生医疗保健延迟的几率降低 9%（0.91，0.89，0.94）。
我们发现，医疗保健延迟的 SES 障碍对外国出生者的影响大于美国出生者。较高的健康素养可能会减轻美国癌症幸存者的医疗保健延迟。医疗保健提供者、系统和政策制定者应评估和解决健康的社会决定因素，并促进健康素养，以尽量减少外国出生和美国出生的癌症幸存者的医疗保健延迟。
