Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan, USA.
Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan, USA.
Cancer. 2024 Jun 1;130(11):2060-2073. doi: 10.1002/cncr.35212. Epub 2024 Jan 27.
Social risks are common among cancer survivors who have the fewest financial resources; however, little is known about how prevalence differs by age at diagnosis, despite younger survivors' relatively low incomes and wealth.
The authors used data from 3703 participants in the Detroit Research on Cancer Survivors (ROCS) cohort of Black cancer survivors. Participants self-reported several forms of social risks, including food insecurity, housing instability, utility shut-offs, not getting care because of cost or lack of transportation, and feeling unsafe in their home neighborhood. Modified Poisson models were used to estimate prevalence ratios and 95% confidence intervals (CIs) of social risks by age at diagnosis, controlling for demographic, socioeconomic, and cancer-related factors.
Overall, 35% of participants reported at least one social risk, and 17% reported two or more risks. Social risk prevalence was highest among young adults aged 20-39 years (47%) followed by those aged 40-54 years (43%), 55-64 years (38%), and 65 years and older (24%; p for trend < .001). Compared with survivors who were aged 65 years and older at diagnosis, adjusted prevalence ratios for any social risk were 1.75 (95% CI, 1.42-2.16) for survivors aged 20-39 years, 1.76 (95% CI, 1.52-2.03) for survivors aged 40-54 years, and 1.41 (95% CI, 1.23-1.60) for survivors aged 55-64 years at diagnosis. Similar associations were observed for individual social risks and experiencing two or more risks.
In this population of Black cancer survivors, social risks were inversely associated with age at diagnosis. Diagnosis in young adulthood and middle age should be considered a risk factor for social risks and should be prioritized in work to reduce the financial effects of cancer on financially vulnerable cancer survivors.
社会风险在癌症幸存者中很常见，而这些幸存者的经济资源最少；然而，尽管年轻的幸存者收入和财富相对较低，但人们对不同诊断年龄的患病率差异知之甚少。
作者使用了来自底特律癌症幸存者研究（ROCS）队列的 3703 名黑人癌症幸存者的数据。参与者自我报告了几种形式的社会风险，包括食物无保障、住房不稳定、水电费被切断、因费用或缺乏交通工具而无法获得护理以及在家附近感到不安全。使用修正后的泊松模型估计了按诊断年龄划分的社会风险的患病率比和 95%置信区间（CI），控制了人口统计学、社会经济和癌症相关因素。
总体而言，35%的参与者报告了至少一种社会风险，17%的参与者报告了两种或更多种风险。社会风险的患病率在 20-39 岁的年轻成年人中最高（47%），其次是 40-54 岁的成年人（43%）、55-64 岁的成年人（38%）和 65 岁及以上的成年人（24%；p<0.001）。与诊断时年龄在 65 岁及以上的幸存者相比，诊断时年龄在 20-39 岁的幸存者的任何社会风险的调整后患病率比为 1.75（95%CI，1.42-2.16），诊断时年龄在 40-54 岁的幸存者为 1.76（95%CI，1.52-2.03），诊断时年龄在 55-64 岁的幸存者为 1.41（95%CI，1.23-1.60）。对于个别社会风险和经历两种或更多种风险，也观察到了类似的关联。
在本黑人癌症幸存者人群中，社会风险与诊断年龄呈反比。年轻成年和中年时的诊断应被视为社会风险的一个危险因素，并应优先考虑降低经济上脆弱的癌症幸存者癌症对财务影响的工作。
