Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
Health Management Center of University-Town Hospital Affiliated to Chongqing Medical University, Chongqing, 401331, China.
BMC Med. 2024 Aug 26;22(1):343. doi: 10.1186/s12916-024-03563-0.
Racial and ethnic disparities in mortality persist among US cancer survivors, with social determinants of health (SDoH) may have a significant impact on these disparities.
A population-based cohort study of a nationally representative sample of adult cancer survivors, who participated in the US National Health and Nutrition Examination Survey from 1999 to 2018 was included. Sociodemographic characteristics and SDoH were self-reported using standardized questionnaires in each survey cycle. The SDoH was examined by race and estimated for associations with primary outcomes, which included all-cause and cancer-specific mortality. Multiple mediation analysis was performed to assess the contribution of each unfavorable SDoH to racial disparities to all-cause and cancer-specific mortality.
Among 5163 cancer survivors (2724 [57.7%] females and 3580 [69.3%] non-Hispanic White individuals), only 881 (24.9%) did not report an unfavorable SDoH. During the follow-up period of up to 249 months (median 81 months), 1964 deaths were recorded (cancer, 624; cardiovascular, 529; other causes, 811). Disparities in all-cause and cancer-specific mortality were observed between non-Hispanic Black and White cancer survivors. Unemployment, lower economic status, education less than high school, government or no private insurance, renting a home or other arrangements, and social isolation were significantly and independently associated with worse overall survival. Unemployment, lower economic status, and social isolation were significantly associated with cancer-specific mortality. Compared to patients without an unfavorable SDoH, the risk of all-cause mortality was gradually increased in those with a cumulative number of unfavorable SDoHs (1 unfavorable SDoH: hazard ratio [HR] = 1.54, 95% CI 1.25-1.89; 2 unfavorable SDoHs: HR = 1.81, 95% CI 1.46-2.24; 3 unfavorable SDoHs: HR = 2.42, 95% CI 1.97-2.97; 4 unfavorable SDoHs: HR = 3.22, 95% CI 2.48-4.19; 5 unfavorable SDoHs: HR = 3.99, 95% CI 2.99-5.33; 6 unfavorable SDoHs: HR = 6.34 95% CI 4.51-8.90). A similar trend existed for cancer-specific mortality.
In this cohort study of a nationally representative sample of US cancer survivors, a greater number of unfavorable SDoH was associated with increased risks of mortality from all causes and cancer. Unfavorable SDoH levels were critical risk factors for all-cause and cancer-specific mortality, as well as the underlying cause of racial all-cause mortality disparities among US cancer survivors.
在美国癌症幸存者中，种族和民族间的死亡率仍存在差异，健康的社会决定因素（SDoH）可能对这些差异有重大影响。
这项基于人群的队列研究纳入了参加过美国国家健康和营养检查调查（1999 年至 2018 年）的全国代表性成年癌症幸存者的样本。社会人口统计学特征和 SDoH 通过每个调查周期的标准化问卷进行自我报告。通过种族来检查 SDoH，并评估其与主要结局的相关性，主要结局包括全因死亡率和癌症特异性死亡率。采用多重中介分析评估每个不利 SDoH 对全因和癌症特异性死亡率的种族差异的贡献。
在 5163 名癌症幸存者（2724 名女性[57.7%]和 3580 名非西班牙裔白人个体[69.3%]）中，只有 881 名（24.9%）未报告不利 SDoH。在长达 249 个月（中位数 81 个月）的随访期间，记录了 1964 例死亡（癌症 624 例，心血管疾病 529 例，其他原因 811 例）。非西班牙裔黑人和白种癌症幸存者的全因死亡率和癌症特异性死亡率存在差异。失业、经济状况较低、教育程度低于高中、政府或无私人保险、租房或其他安排以及社会孤立与整体生存率较差显著相关。失业、经济状况较低和社会孤立与癌症特异性死亡率显著相关。与无不利 SDoH 的患者相比，具有累积数量不利 SDoH 的患者全因死亡率风险逐渐增加（1 个不利 SDoH：风险比[HR] = 1.54，95%CI 1.25-1.89；2 个不利 SDoH：HR = 1.81，95%CI 1.46-2.24；3 个不利 SDoH：HR = 2.42，95%CI 1.97-2.97；4 个不利 SDoH：HR = 3.22，95%CI 2.48-4.19；5 个不利 SDoH：HR = 3.99，95%CI 2.99-5.33；6 个不利 SDoH：HR = 6.34，95%CI 4.51-8.90）。癌症特异性死亡率也存在类似的趋势。
在这项对美国癌症幸存者进行的全国代表性样本的队列研究中，更多不利的 SDoH 与全因死亡率和癌症死亡率的增加相关。不利的 SDoH 水平是全因和癌症特异性死亡率的关键危险因素，也是美国癌症幸存者全因死亡率种族差异的根本原因。
