Cancer
Implications of neighborhood socioeconomic status on work ability among cancer survivors in the UNC Cancer Survivorship Cohort Yung-Fang Deng* Yung-Fang Deng Mu Jin Brent J. Small Laura Farnan Tzy-Mey Kuo Hazel B. Nichols
Background: Work ability is critical for cancer survivors due to its connections to cancer-related financial hardship and quality of life. We examined the association between neighborhood socioeconomic status (SES) and work ability among cancer survivors.
Methods: Among cancer survivors in the UNC Cancer Survivorship Cohort (2010-2016), neighborhood SES was assessed using the census-tract level Yost index (state-based quintiles, Q1-Q5) linked to residential addresses at enrollment, where lower quintiles represent lower SES areas. Participants completed the modified Work Ability Index, including a general score (0-10), composite physical/mental score (2-10), and number of annual missed days of work. We estimated mean differences (β) and 95% confidence intervals (CI) in work ability across Yost quintiles using multivariable linear regression, overall and in subgroup analyses stratified by cancer type, chemotherapy status, time since diagnosis, and rurality.
Results: Among 1,326 currently working participants in the cohort, mean age was 54.4 at survey and 53.1 at diagnosis; 11.1% of the cohort lived in the lowest SES quintile. We observed higher general work ability (β= 0.68, 95% CI: 0.13, 1.22) and composite physical/mental ability (β= 0.38, 95% CI: 0.05, 0.71) scores in Q5 vs. Q1 of the Yost index. In subgroup analyses, we observed fewer annual missed days in Q5 vs. Q1 of the Yost index among survivors who did not receive chemotherapy (N=1,006; β= -13.70, 95% CI: -22.26, -5.14); prostate cancer survivors (N=134; β= -26.71, 95% CI: -42.62, -10.81); those diagnosed within a year (N=995; β= -11.50, 95% CI: -21.32, -1.68); and those in urban areas (N=1,017; β= -16.48, 95% CI: -29.14, -3.82).
Conclusion: Our findings suggest that disparities in work ability exist across neighborhood SES, with those in higher SES areas reporting better work ability. These contribute to the evidence supporting interventions to rebuild or protect work ability among cancer survivors.