Background: According to the Center for Disease Control, Social Determinants of Health (SDOH) are conditions in which people are born, grow, work, live and age and may contribute to poorer health and mental health. The aims of this study were to examine the association between SDOH and symptom burden and health outcomes in those diagnosed with cancer and their family caregivers.
Methods: Using geocoding, we examined the associations with SDOH including income inequality, segregation, area deprivation, and rurality with symptom burden and health outcomes, including survival and 10-year risk of CVD, were assessed in patients and family caregivers, respectively. Linear and Cox regression was performed to examine associations between SDOH, symptom burden and health outcomes.
Results: Of the 459 patients, 44% were male, mean age 65.7 (SD=11.4) years, and 92.6% White. Of the 211 family caregivers, 31% were male, mean age = 62.4 (SD=12.3), and the majority (94.7%) were white. The SDOH of patients and family caregivers were significantly correlated (Pearson r=.314-0.923, p=0.01-<0.001) as 74.7% of the family caregivers were intimate partners of the patients. We observed that higher patient income inequality was not associated with higher symptom burden [p=0.621] or perceived stress [p=0.880] but was associated with poorer survival [B=-3.0094, SE=1.147, HR=0.045, p=0.006]. Family caregiver income inequality was significantly associated with depressive symptoms (B=33.810, SE=14.981, p=0.026) but not caregiver-related stress (p=0.112), sleep quality (p=0.658), perceive stress (p=0.307), or 10-year risk of CVD (p=0.357). Higher family caregiver area deprivation was associated with higher perceived stress (B=0.066, SE=0.032, p=0.042). Patient area deprivation, patient and family caregiver segregation, and patient and family caregiver rurality were not associated with symptom burden or health outcomes.
Conclusion: Multi-level interventions are warranted to address SDOH to reduce symptom burden and improve health outcomes in patients diagnosed with cancer and their family caregivers.