Journal: Cancer research communications
This publication uses 2022–2023 Behavioral Risk Factor Surveillance System data (over 470,000 respondents, representing ~266 million U.S. adults) to compare multiple social risks in adults with and without a history of cancer.
Key design points:
- Population: U.S. adults, 18+ years; 8.7% reported a prior cancer diagnosis.
- Social risks measured (7 domains): food insecurity (2 items), housing insecurity, utility insecurity, employment insecurity, transportation insecurity, and cost-related barriers to medical care.
- Analyses: prevalence and absolute differences in social risks by cancer history, stratified by age (18–39, 40–64, 65+). Among 18–39-year-olds, further stratified by Medicaid expansion status, race/ethnicity, and sex.
Main findings:
- Young adults (18–39): those with a cancer history have substantially higher prevalence of nearly all social risks than their peers without cancer.
- Middle-aged adults (40–64): these differences lessen in this age group.
- Older adults (65+): differences are absent or reversed, likely reflecting Medicare eligibility and different economic supports in older age.
Among young adult survivors:
- Medicaid expansion status: social risk gaps versus non-cancer peers are larger in non–Medicaid expansion states for SNAP participation, housing and utility insecurity, and cost-related barriers to care.
- Race/ethnicity: racially and ethnically minoritized groups have higher absolute prevalence of all social risks; however, the difference between survivors and non-survivors is often largest among non-Hispanic White adults.
- Sex: males show larger survivor–nonsurvivor gaps than females across several risk domains.
Clinical and policy implications:
- Disproportionate risk: young adult cancer survivors are at disproportionate risk for social and financial hardship, particularly in states without Medicaid expansion.
- Care priorities: screening for social risks and proactive connection to food, housing, utility, transportation, and financial assistance should be prioritized in survivorship care for younger adults.
- Targeted interventions: interventions need to account for intersections of age, insurance policy context, race/ethnicity, and sex to reduce survivorship inequities.