Cumulative social risk exposure and risk of cancer mortality in adulthood.

Rishi Caleyachetty,Justin B Echouffo-Tcheugui,Parisa Tehranifar,Peter Muennig,Jeanine M Genkinger

doi:10.1186/s12885-015-1997-z

Abstract

BackgroundAdults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime. However, cancer epidemiology tends to focus on single social risk factors at a time. We examined the prospective association between cumulative social risk exposure and deaths from cancer in a nationally representative sample of U.S. adults.MethodsThe study included 8745 adults (aged ≥ 40 years) in the NHANES Survey III Mortality Study over a median follow-up of 13.5 years (1988-1994 enrollment dates and 1988 through 2006 for mortality data). Social risk factors (low family income, low education level, minority race, and single-living status) were summed to create a cumulative social risk score (0 to ≥3). We used Cox proportional hazard models to estimate age- and sex-adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CI) for the association between cumulative social risk with deaths from all-cancers combined, tobacco-related cancers, and screening-detectable cancers.ResultsDeaths from all-cancers combined (P for trend = 0.001), tobacco-related cancers (P for trend = <0.001), and lung cancer (P for trend = 0.01) increased with an increasing number of social risk factors. As compared with adults with no social risk factors, those exposed to ≥3 social risk factors were at increased risk of deaths from all-cancers combined (HR = 1.8, 95 % CI = 1.3-2.4), tobacco-related cancers (HR = 2.6, 95 % CI: 1.6-4.0), and lung cancer (HR = 2.3, 95 % CI = 1.3-4.1).ConclusionsU.S. adults confronted by higher amounts of cumulative social risk appear to have increased mortality from all-cancers combined, tobacco-related cancers, and lung cancer. An enhanced understanding of the cumulative effect of social risk factors may be important for targeting interventions to address social disparities in cancer mortality.

Highlights

Adults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime
Cumulative social risk exposure refers to experiencing more than one social risk factor at a time, and may better represent the complexity of social disadvantage compared to individual social risk factors [14, 15]
We examined if the risk of cancer mortality and each social risk factor was modified by sex by adding a cross-product term between each factor and sex to the model and evaluating the coefficient using a Wald Test

Summary

Introduction

Adults in the United States (U.S) can be simultaneously exposed to more than one social risk factor over their lifetime. Disadvantaged adults may be exposed to multiple social risk factors simultaneously, with exposure occurring across time and domains [14]. Cumulative social risk exposure refers to experiencing more than one social risk factor at a time, and may better represent the complexity of social disadvantage compared to individual social risk factors [14, 15]. Given that these social risk factors can influence multiple health outcomes and operate via multiple and overlapping mechanisms [16], their co-occurrence as captured through an index of cumulative social risk may lead to larger health adversities, including mortality risk.

Methods

Results

Conclusion