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Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study
Author(s) -
Pinheiro Laura C.,
Reshetnyak Evgeniya,
Akinyemiju Tomi,
Phillips Erica,
Safford Monika M.
Publication year - 2022
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.33894
Subject(s) - medicine , hazard ratio , social determinants of health , demography , interquartile range , cohort , cancer , cohort study , health equity , proportional hazards model , gerontology , public health , confidence interval , pathology , sociology
Background Social determinants of health (SDOHs) cluster together and can have deleterious impacts on health outcomes. Individually, SDOHs increase the risk of cancer mortality, but their cumulative burden is not well understood. The authors sought to determine the combined effect of SDOH on cancer mortality. Methods Using the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, the authors studied 29,766 participants aged 45+ years and followed them 10+ years. Eight potential SDOHs were considered, and retained SDOHs that were associated with cancer mortality ( P < .10) were retained to create a count (0, 1, 2, 3+). Cox proportional hazard models estimated associations between the SDOH count and cancer mortality through December 31, 2017, adjusting for confounders. Models were age‐stratified (45‐64 vs 65+ years). Results Participants were followed for a median of 10.6 years (interquartile range [IQR], 6.5, 12.7 years). Low education, low income, zip code poverty, poor public health infrastructure, lack of health insurance, and social isolation were significantly associated with cancer mortality. In adjusted models, among those <65 years, compared to no SDOHs, having 1 SDOH (adjusted hazard ratio [aHR], 1.39; 95% CI, 1.11‐1.75), 2 SDOHs (aHR, 1.61; 95% CI, 1.26‐2.07), and 3+ SDOHs (aHR, 2.09; 95% CI, 1.58‐2.75) were associated with cancer mortality ( P for trend <.0001). Among individuals 65+ years, compared to no SDOH, having 1 SDOH (aHR, 1.16; 95% CI, 1.00‐1.35) and 3+ SDOHs (aHR, 1.26; 95% CI, 1.04‐1.52) was associated with cancer mortality ( P for trend = .032). Conclusions A greater number of SDOHs were significantly associated with an increased risk of cancer mortality, which persisted after adjustment for confounders.