Zhao Fangyuan, Freeman Jincong Q, Jaskowiak Nora, Fleming Gini F, Nanda Rita, Lauderdale Diane S, Olopade Olufunmilayo I, Huo Dezheng
Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA.
Department of Surgery, University of Chicago, Chicago, Illinois, USA.
Stress Health. 2025 Jun;41(3):e70063. doi: 10.1002/smi.70063.
As COVID-19 transitions to a more manageable phase, it remains unclear whether its impact on mental health has similarly eased among cancer survivors. This longitudinal study tracked how the levels of stress and isolation experienced by breast cancer survivors (BCS) of different racial/ethnic groups have changed as the pandemic evolved. BCS enroled in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort were surveyed between July and September of 2020, 2021, and 2022. An 11-item isolation/stress score was repeatedly measured in each survey. Mixed-effects linear regression models were used to analyse changes in the isolation/stress scores over time across different racial/ethnic groups and to identify the socioeconomic factors associated with the racial disparities observed. In total, 1899 BCS responded (response rate: 62.8%), of whom 69% were White and 24% Black. The median time from diagnosis to first survey was 5.1 years (IQR: 2.3-9.2). The isolation/stress score decreased continuously for White BCS (P-trend < 0.001), but only began declining for Black BCS in the last wave of survey. Black BCS had significantly higher isolation/stress scores in 2021 and 2022 compared to Whites (both p < 0.01). The racial differences became insignificant after adjusting for certain socioeconomic factors. Notably, BCS who were single, on Medicaid, without a high school degree, or with annual household income less than $35,000 had significantly higher isolation/stress scores (all p < 0.05). The findings remained consistent in sensitivity analysis using inverse probability weighting to account for non-response. Our findings suggested that the levels of stress and isolation of BCS did not improve equally across different racial/ethnic groups as the pandemic subsided. This may be associated with disparities in socioeconomic factors like insurance coverage, education level, income level and family composition. Understanding these barriers and challenges is crucial for developing targeted interventions and support systems for vulnerable populations as we recover from the pandemic and prepare for future health challenges.
随着新冠疫情过渡到一个更易于管控的阶段，目前仍不清楚其对癌症幸存者心理健康的影响是否也同样有所缓解。这项纵向研究追踪了不同种族/族裔群体的乳腺癌幸存者（BCS）在疫情发展过程中所经历的压力和孤独感水平是如何变化的。对纳入芝加哥多族裔乳腺癌流行病学队列的BCS在2020年7月至9月、2021年以及2022年进行了调查。每次调查中都重复测量了一个包含11个项目的孤独感/压力得分。使用混合效应线性回归模型来分析不同种族/族裔群体中孤独感/压力得分随时间的变化，并确定与所观察到的种族差异相关的社会经济因素。共有1899名BCS做出了回应（回应率：62.8%），其中69%为白人，24%为黑人。从诊断到首次调查的中位时间为5.1年（四分位间距：2.3 - 9.2）。白人BCS的孤独感/压力得分持续下降（P趋势<0.001），但黑人BCS直到最后一轮调查才开始下降。与白人相比，黑人BCS在2021年和2022年的孤独感/压力得分显著更高（均p<0.01）。在调整某些社会经济因素后，种族差异变得不显著。值得注意的是，单身、参加医疗补助计划、没有高中学历或家庭年收入低于35,000美元的BCS的孤独感/压力得分显著更高（均p<0.05）。在使用逆概率加权进行敏感性分析以考虑无回应情况时，研究结果保持一致。我们的研究结果表明，随着疫情缓解，不同种族/族裔群体的BCS的压力和孤独感水平并没有同等程度地改善。这可能与保险覆盖范围、教育水平、收入水平和家庭构成等社会经济因素的差异有关。在我们从疫情中恢复并为未来的健康挑战做准备时，了解这些障碍和挑战对于为弱势群体制定有针对性的干预措施和支持系统至关重要。
