Cancer
Social risks and mortality among Black cancer survivors: results from the Detroit Research on Cancer Survivors (ROCS) cohort Theresa A. Hastert* Theresa Hastert Julie J. Ruterbusch Nora Akcasu Ann G. Schwartz
Background: Social risks, or adverse factors associated with poor health, are increasingly considered important predictors of cancer outcomes. This study estimates associations between social risks and mortality among Black cancer survivors.
Methods: We utilized data from 4,069 participants in the Detroit Research on Cancer Survivors cohort. Black adults were invited to participate if they were ages 20-79 at diagnosis with breast, colorectal, lung, or prostate cancer since 1/1/13; or with endometrial cancer (ages 20-79) or any other cancer (ages 20-49) since 1/1/16. Cases were identified through a population-based cancer registry. Patient-reported social risks, including food insecurity, utility shut-offs, housing instability, inability to get medical care due to cost or lack of transportation, and perceptions of neighborhood safety were assessed at ROCS enrollment. Cox proportional hazards models estimated associations between social risks and 10-year all-cause mortality using months since diagnosis as the time scale. All models adjusted for age. Fully adjusted models include income, insurance, site, stage, and treatments received.
Results: At ROCS enrollment, 37% of participants reported any social risks. In age-adjusted models, any social risk was associated with 38% higher mortality (95% CI: 1.21-1.58). Food insecurity (HR: 1.41, 95% CI: 1.18-1.69), housing instability (HR: 1.42, 95% CI: 1.17-1.73), forgoing care due to lack of transportation (HR: 1.79, 95% CI: 1.49-2.15), feeling unsafe in the home neighborhood (HR: 1.25, 95% CI: 1.00-1.55), and utility shut-offs (HR: 1.38, 95% CI: 1.10-1.72) were each associated with higher mortality. Associations attenuated in fully adjusted models, but forgoing care due to lack of transportation remained associated with 31% (95% CI: 1.07, 1.61) higher mortality risk.
Conclusions: Social risks, particularly lack of transportation to care, reflect potentially modifiable risk factors for mortality among Black cancer survivors.