Association of Modifiable Health Conditions and Social Determinants of Health With Late Mortality in Survivors of Childhood Cancer

• DOI: 10.1001/jamanetworkopen.2022.55395
• Publication Date: 2023-02-10T17:48:55Z
• Authors: Matthew J. Ehrhardt; Qi Liu; Stephanie B. Dixon; Eric Caron; Debbie Redd; Kyla Shelton; I-Chan Huang; Nickhill Bhakta; Kirsten K. Ness; Daniel A. Mulrooney; Tara M. Brinkman; Wassim Chemaitilly; Angela Delaney; Gregory T. Armstrong; Deo Kumar Srivastava; Alia Zaidi; Leslie L. Robison; Yutaka Yasui; Melissa M. Hudson
• Keywords: National Death Index; Underweight

Associations between modifiable chronic health conditions (CHCs), social determinants of health, and late mortality (defined as death occurring ≥5 years after diagnosis) in childhood cancer survivors are unknown.To explore associations CHCs within the context health.This longitudinal cohort study used data from 9440 individuals who were eligible to participate St Jude Lifetime Cohort (SJLIFE), a retrospective with prospective clinical follow-up that was initiated 2007 characterize outcomes among survivors. Eligible had survived 5 or more diagnosis, diagnosed 1962 2012, received treatment at Children's Research Hospital included estimates. A total 3407 adult SJLIFE participants (aged ≥18 years) completed an on-campus assessment risk factor analyses. Vital status, date death, cause obtained by linkage National Death Index (coverage inception December 31, 2016). Deaths before Cancer Registry. Data analyzed June 2022.Data on exposures causes abstracted for study. Information (dyslipidemia, hypertension, diabetes, underweight obesity, bone mineral deficiency, hypogonadism, hypothyroidism, adrenal insufficiency, all graded modified Common Terminology Criteria Adverse Events), healthy lifestyle index (smoking alcohol consumption, body mass [calculated weight kilograms divided height meters squared], physical activity), area deprivation (ADI; which measures neighborhood-level socioeconomic disadvantage), frailty (low lean muscle mass, exhaustion, low energy expenditure, slowness, weakness) participants.National estimate using standardized ratios (SMRs) 95% CIs, calculated based US rates. For analyses (among assessment), multivariable piecewise exponential regression analysis rate (RRs) CIs all-cause cause-specific mortality.Among study, median (range) age 27.5 (5.3-71.9) years, duration 18.8 (5.0-58.0) years; 55.2% male 75.3% non-Hispanic White. Survivors experienced increases (SMR, 7.6; CI, 7.2-8.1) health-related 7.0-8.2). Among assessment, 35.4 (17.9-69.8) 27.3 (7.3-54.7) 52.5% 81.7% Models adjusted attained age, sex, race ethnicity, exposures, household income, employment insurance status revealed having 1 CHC grade 2 higher (RR, 2.2; 1.2-4.0; P = .01), 2.6; 1.4-4.9; .003), 3 3.6; 1.8-7.1, < .001); living Census block ADI 51st 80th percentile 5.5; 1.3-23.5; .02), 81st 100th 8.7; 2.0-37.6; .004), unassigned 15.7; 3.5-70.3; 2.3; 1.3-3.9; .004) associated significant death. Similar observed (1 ≥2: RR, 2.2 [95% 1.1-4.4; .02]; 2.5 1.2-5.2; .01]; 4.0 1.9-8.4; .001]; 51st-80th percentile: 9.2 1.2-69.7; .03]; 81st-100th 16.2 2.1-123.7; .007], ADI: 3.5-213.6; .002]; frailty: 2.3 1.2-4.1; .009]).In this survivors, high independently increased cancer. Future investigations seeking mitigate these factors will be important improving developing risk-stratification strategies optimize care delivery