Unveiling the interplay of social factors in cancer survivorship: A comprehensive social determinants of health (SDOH) profile analysis.

Abstract

1536 Background: SDOHs contribute to patients’ cancer survivorship outcomes. While studies tend to focus on individual SDOH, understanding the interplay and collective impact of multiple SDOHs is vital for improving patient outcomes and access to care. Our study aims to understand SDOH profiles in cancer survivors and stratify social risks by analyzing relationships between SDOH profiles and health outcomes using a nationally representative dataset. Methods: We conducted an unsupervised clustering analysis using 2013-2018 National Health Interview Survey data, linked to NHIS Mortality Files, to examine 12 social determinants of health (SDOHs) in the general population. 12 SDOH included unmarried status, unemployment, less than high school education, material/psychological/behavioral financial hardship, transportation/food/housing insecurity, delayed care due to other reasons, and low income(less than federal poverty line), and low neighborhood cohesion. K-Modes clustering was used to identify optimal number of cluster. We estimated each cluster’s prevalence in younger (18-64 years) and older (65-79 years) cancer survivors, then used weighted Cox regression to assess the risk of overall (OS)in both age groups, adjusting for demographics. Results: We identified 5 distinct groups based their SDOH profiles, including group A (few SDOH barriers), B (unmarried but no other SDOH barriers), C (unemployed but no other SDOH barriers), D (unmarried, unemployed, occasionally having other SDOH barriers) and E (the highest rate of financial hardship/transportation/food/housing insecurity/low neighborhood cohesion/low income). Notably, group E, compared to all other groups, had the highest rate of racial minorities in both younger and older groups in both younger (71% vs 5-14%) and older populations (74% vs 1-8%). Older survivors in Group C (HR 2.48, 95% CI: 1.02-6.03), Group D (HR 4.09, 95% CI: 1.65-10.14), and Group E (HR 3.88, 95% CI: 1.44-10.46) had significantly lower OS rates compared to those in Group A. For younger survivors, Group D (HR 1.96, 95% CI: 0.97-3.96) and Group E (HR 1.40, 95% CI: 0.67-2.95) were associated with nonsignificant reductions in OS, possibly due to limited sample sizes. Conclusions: SDOHs form distinct clusters, each with profound on cancer survivorship especially among older survivors facing complex social challenges. This necessitates customized health interventions focused on these SDOH profiles, crucial for improving patient outcomes and addressing health disparities.