non-Hispanic White Cancer Survivors Research Articles

Sociodemographic differences in suicide/intentional self-harm among cancer survivors versus the general United States population.

11097 Background: Suicide is a national public health crisis, and one of the leading causes of death in the United States. Worse yet, the suicide mortality rate is at least double among cancer survivors compared to the general population. Suicide rates vary across the population, but it is unclear how sociodemographic factors explain differences in suicide rates among cancer survivors versus the general United States population. Methods: We analyzed two sets of population-based data. First, we retrieved suicide/self-harm mortality rates for the general population from the National Vital Statistics System. Next, we accessed cancer case data from the Surveillance, Epidemiology, End Results (SEER) program to estimate number of deaths due to suicide/self-harm among cancer patients, per 100,000 persons, with a 95% confidence interval. All analyses were restricted to contiguous states with full state representation in SEER (CA, CT, GA, ID, IA, KY, LA, NJ, NM, NY, TX, UT). We then compared subgroup differences by sex, race/ethnicity, age, and state. Results: In 2020, there were 15,813 deaths in the general population (12.1 suicide/100,000 persons; 95% CI: 11.9, 12.3), and 1,127 among cancer survivors (22.1 suicide/100,000 persons; 95% CI: 22.0, 22.1) due to suicide/intentional self-harm. Among racial/ethnic groups, the largest difference was found in the non-Hispanic White cancer survivors, with 10.4 more suicide/100,000 persons vs. White individuals in the general population. In contrast, two racial minority groups had higher suicide mortality rate in the general population vs. cancer survivors: Non-Hispanic Black individuals (general population = 7.4 suicide/100,000 persons vs cancer survivors = 6.9 suicide/100,000 persons), and Native American Indian (general population = 16.6 suicide/100,000 persons vs. cancer survivors = 11.3 suicide/100,000 persons). Among females, suicide mortality rate was slightly higher by 1.3 suicide/100,000 persons in cancer survivors vs. general population, and much higher among male cancer survivors vs. general population (19.9 suicide/100,000 persons more). For age groups, the lowest difference in suicide mortality between cancer survivors vs. general population was in the 65-84 age group (5.1 more suicide/100,000 persons). Across all other age groups, suicide rates were 11.9 to 14.4 higher in cancer survivors vs. the general population. Across the 12 states in our analysis, the smallest difference was in Iowa (1.9 more suicide/100,000 persons), and the largest difference was in Idaho (27.0 more suicide/100,000 persons). Conclusions: In most subgroups, people diagnosed with cancer appear to be at greater risk of death from suicide/intentional self-harm than the general population. As the number of people living with cancer continues to grow, policies increasing the quality of life for cancer patients are warranted.

Abstract B121: Racial disparities in the association between adverse childhood experiences and history of self-reported depression among cancer survivors

Abstract Introduction. Depression is experienced by 25% of cancer survivors in the United States, and there are racial differences in how adverse childhood experiences (ACEs) affect depression. While previous studies have examined association between ACEs and depression in general population, studies focusing on cancer survivors are lacking. The purpose of this study was to assess the association between ACEs and history of self-reported depression among cancer survivors in different race groups. Methods. This study was a cross-sectional analysis of the 2020 Behavioral Risk Factor Surveillance System among 19,241 cancer survivors. The ACE category (zero, one, two-three, ≥four) included questions assessing exposure to eight types of adverse childhood experiences: three types of abuse (physical, emotional, and sexual) and five types of household challenges (household member substance misuse, incarceration, mental illness, parental divorce, or witnessing intimate partner violence) before age 18 years. The outcome is self-reported history of depression (yes/no). Three weighted multivariable logistic regression models were used to examine the association between ACE and depression for each race group: Non-Hispanic White (NHW), Non-Hispanic Black (NHB) and Hispanics, adjusting for age, sex, smoking status, income, education, marital status, body mass index, health status. Results. In this sample of cancer survivors, 41%, 22%, 21% and 16% reported having experienced zero, one, two-three, and >=4 ACEs respectively. Majority of survivors were NHW (82.5%) while 6.2%, 6.4% and 4.9% were NHB, Hispanics, and Others respectively. Personal history of depression was reported by 21% of survey respondents. Among survivors experiencing >=4 ACEs, depression was reported by 46.9 % of NHW, 55.2% of NHB and 50.6% of Hispanics. In the adjusted models, among NHW survivors with 1 ACE (aOR: 1.7, 95% CI. 1.3– 2.2), 2-3 ACEs (aOR: 1.9, 95% CI. 1.5– 2.4), or >=4 ACES (aOR: 4.2, 95% CI. 3.3– 5.5) had higher odds of depression compared with those with zero ACEs. Among NHB, survivors with >=4 ACEs had higher odds of depression (aOR: 2.5, 95% CI. 1.2– 5.0) compared with those with zero ACEs; no significant difference was observed for survivors with 1 or 2-3 ACEs. Similarly, among Hispanics, survivors with >=4 ACEs had higher odds of depression (aOR: 11.3, 95% CI. 5.4– 23.8) compared with those with zero ACEs whiles no significant difference was observed for survivors with 1 or 2-3 ACEs. Conclusion. Persons with ACEs may represent an important targeted prevention group to reduce risk of depression among cancer survivors. While there is a relationship between all categories of ACE and depression among NHW cancer survivors, only those with >=4 ACEs had association with depression among NHB and Hispanics. Potential variation by race warrants additional studies regarding potential for selective prevention and identification of resilient, cultural, and healthcare access factors. Citation Format: Oluwole A. Babatunde, Melanie S. Jefferson, Swann A. Adams, Chanita Hughes Halbert, Frank Clark, Anusuiya Nagar, Nosayaba Osazuwa-Peters, Eric A. Boakye. Racial disparities in the association between adverse childhood experiences and history of self-reported depression among cancer survivors [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B121.

Health-related Quality of Life in Elderly Asian American and Non-Hispanic White Cancer Survivors.

The purpose of this study was to assess predictors of health-related quality of life (HRQoL) in elderly Asian American and non-Hispanic White cancer survivors. We conducted cross-sectional secondary data analyses using the combined datasets from the Surveillance, Epidemiology, and End Results program and the Medicare Health Outcomes Survey. Elderly Asian American cancer survivors reported a lower mental HRQoL but a comparable physical HRQoL relative to elderly non-Hispanic White cancer survivors. Stress factors, such as comorbidities, difficulties with activities of daily living, and a history of depressive symptoms, along with coping resources like self-rated health and the ability to take the survey in English, were significantly associated with mental and physical HRQoL. Among elderly Asian American cancer survivors, a significantly lower mental HRQoL was observed among those taking the survey in the Chinese language. The findings suggest that race exerts a differential impact on HRQoL. Interventions should be designed to address the distinct cultural, linguistic, and systemic needs of elderly Asian American cancer survivors. Such an approach could assist in reducing cancer-related health disparities.

Medical financial hardship reported by Native Hawaiian and Pacific Islander cancer survivors compared with non‐Hispanic whites

Although medical financial hardship (MFH) resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about MFH among Native Hawaiian and Pacific Islander (NHPI) cancer survivors. One hundred fifty adult NHPI cancer survivors were identified from the 2014 NHPI National Health Interview Survey (NHIS). Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). MFH was defined by 3 domains: 1) material (problem paying or unable to pay medical bills); 2) psychological (worrying about paying medical bills); and 3) behavioral (delaying or forgoing medical care for financial reasons). For comparison, 2098 non-Hispanic white (NHW) cancer survivors were identified from the 2014 NHIS. Logistic regressions were used to identify sociodemographic and health factors associated with experiencing MFH. Stratified analysis by age (<65 vs ≥65years) and sensitivity analysis using propensity score-matched NHPI and NHW cancer survivors were conducted. Nationally representative estimates were generated using survey weights. Among elderly cancer survivors, more NHPIs reported any MFH (59% vs 32%; P=.001), psychological MFH (36% vs 22%; P=.040), and behavioral MFH (27% vs 9%; P=.004) than NHWs. Among survivors aged <65years, NHPIs reported less MFH (46% vs. 65%; P=.034). Even after propensity score matching, these patterns persisted. Female NHPIs and NHPIs with a college degree were significantly more likely to report MFH, especially material and psychological MFH. A significantly higher proportion of elderly NHPI cancer survivors reported MFH, and this difference persisted even after propensity score matching, which warrants further investigation.

Nonlinear Predictive Models for Multiple Mediation Analysis: With an Application to Explore Ethnic Disparities in Anxiety and Depression Among Cancer Survivors.

Mediation analysis allows the examination of effects of a third variable (mediator/confounder) in the causal pathway between an exposure and an outcome. The general multiple mediation analysis method (MMA), proposed by Yu et al., improves traditional methods (e.g., estimation of natural and controlled direct effects) to enable consideration of multiple mediators/confounders simultaneously and the use of linear and nonlinear predictive models for estimating mediation/confounding effects. Previous studies find that compared with non-Hispanic cancer survivors, Hispanic survivors are more likely to endure anxiety and depression after cancer diagnoses. In this paper, we applied MMA on MY-Health study to identify mediators/confounders and quantify the indirect effect of each identified mediator/confounder in explaining ethnic disparities in anxiety and depression among cancer survivors who enrolled in the study. We considered a number of socio-demographic variables, tumor characteristics, and treatment factors as potential mediators/confounders and found that most of the ethnic differences in anxiety or depression between Hispanic and non-Hispanic white cancer survivors were explained by younger diagnosis age, lower education level, lower proportions of employment, less likely of being born in the USA, less insurance, and less social support among Hispanic patients.