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Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study.

Publication ,  Journal Article
Pinheiro, LC; Reshetnyak, E; Akinyemiju, T; Phillips, E; Safford, MM
Published in: Cancer
January 1, 2022

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.

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Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

January 1, 2022

Volume

128

Issue

1

Start / End Page

122 / 130

Location

United States

Related Subject Headings

  • Stroke
  • Social Determinants of Health
  • Risk Factors
  • Race Factors
  • Oncology & Carcinogenesis
  • Neoplasms
  • Middle Aged
  • Humans
  • Cohort Studies
  • Aged
 

Citation

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Pinheiro, L. C., Reshetnyak, E., Akinyemiju, T., Phillips, E., & Safford, M. M. (2022). Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. Cancer, 128(1), 122–130. https://doi.org/10.1002/cncr.33894
Pinheiro, Laura C., Evgeniya Reshetnyak, Tomi Akinyemiju, Erica Phillips, and Monika M. Safford. “Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study.Cancer 128, no. 1 (January 1, 2022): 122–30. https://doi.org/10.1002/cncr.33894.
Pinheiro LC, Reshetnyak E, Akinyemiju T, Phillips E, Safford MM. Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. Cancer. 2022 Jan 1;128(1):122–30.
Pinheiro, Laura C., et al. “Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study.Cancer, vol. 128, no. 1, Jan. 2022, pp. 122–30. Pubmed, doi:10.1002/cncr.33894.
Pinheiro LC, Reshetnyak E, Akinyemiju T, Phillips E, Safford MM. Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. Cancer. 2022 Jan 1;128(1):122–130.
Journal cover image

Published In

Cancer

DOI

EISSN

1097-0142

Publication Date

January 1, 2022

Volume

128

Issue

1

Start / End Page

122 / 130

Location

United States

Related Subject Headings

  • Stroke
  • Social Determinants of Health
  • Risk Factors
  • Race Factors
  • Oncology & Carcinogenesis
  • Neoplasms
  • Middle Aged
  • Humans
  • Cohort Studies
  • Aged