{
  "abstract": "Background\n\nThe impact of cancer therapy on chronic health condition (CHC) burden in childhood cancer survivors is well-established; however, the role of neighborhood-level social determinants of health (SDOH) remains underexplored.Methods\n\nIn this single-center cohort study in the U.S., we analyzed 2508 survivors enrolled in the St. Jude Lifetime Cohort Study between 9/13/2007 and 4/20/2020, who were ≥5 years from diagnosis, ≥18 years of age, and had ≥2 clinical assessments. SDOH encompassed social vulnerability (Social Vulnerability Index) and environmental/healthcare access vulnerabilities (e.g., primary care physician [PCP] availability, food inaccessibility), categorized into quartiles. A total of 177 clinically assessed CHCs were aggregated into 48 CHC groups and a global burden. Multivariable logistic regressions examined associations between baseline SDOH and CHC progression from baseline to follow-up, adjusting for clinical and sociodemographic factors. Global CHC burden progression was the prespecified primary outcome; analyses of specific CHC groups and effect modification by personal socioeconomic status were exploratory.Findings\n\nSurvivors residing in the most vs. least vulnerable neighborhoods, characterized by low income (odds ratio [OR]: 1.83, 95% confidence interval [CI]: 1.36-2.46), limited PCP availability (OR: 1.30, 95% CI: 1.03-1.64), and food inaccessibility (OR: 1.49, 95% CI: 1.08-2.07), had higher risks of global CHC burden progression. Living in SDOH-vulnerable neighborhoods was associated with higher risks of new-onset/worsening of multiple CHC groups, including low education for peripheral nervous system disorders (OR: 2.69, 95% CI: 1.63-4.43), food inaccessibility for arrhythmias (OR: 4.36, 95% CI: 1.32-14.35), and poor walkability for abnormal glucose metabolism (OR: 4.60, 95% CI: 1.41-15.04). Among publicly insured survivors, limited PCP availability and poor walkability were associated with higher risk of peripheral musculoskeletal disorder (OR: 6.11, 95% CI: 2.33-16.04, OR: 7.37, 95% CI: 2.82-19.27).Interpretation\n\nSDOH are associated with CHC severity progression among childhood cancer survivors, supporting multilevel social risk assessment in survivorship care and further evaluation of neighborhood-informed risk stratification.Funding\n\nU.S. National Cancer Institute.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 16,
  "authors": [
    {
      "name": "Jaesung Choi"
    },
    {
      "name": "Madeline R. Horan"
    },
    {
      "name": "Sedigheh Mirzaei"
    },
    {
      "name": "Deo Kumar Srivastava"
    },
    {
      "name": "Nickhill Bhakta"
    },
    {
      "name": "Stephanie B. Dixon"
    },
    {
      "name": "Matthew J. Ehrhardt",
      "orcid": "0000-0003-2781-9983"
    },
    {
      "name": "Carmen L. Wilson"
    },
    {
      "name": "Angela Delaney",
      "orcid": "0000-0002-0632-6365"
    },
    {
      "name": "Yikyung Park"
    },
    {
      "name": "Daniel A. Mulrooney"
    },
    {
      "name": "Heather M. Brandt"
    },
    {
      "name": "Kirsten K. Ness"
    },
    {
      "name": "Gregory T. Armstrong"
    },
    {
      "name": "Melissa M. Hudson",
      "orcid": "0000-0001-6984-2407"
    },
    {
      "name": "I-Chan Huang",
      "orcid": "0000-0002-1194-3923"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/e3mp83m94jdz3.bib",
  "cited_by": 0,
  "doi": "10.1016/j.eclinm.2026.104255",
  "fulltext_url": "https://europepmc.org/articles/PMC13685892",
  "id": "e3mp83m94jdz3",
  "issns": [
    "2589-5370"
  ],
  "landing_url": "https://linkinghub.elsevier.com/retrieve/pii/S2589537026005080",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "http://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2735|Childhood Cancer Survivors' Quality of Life"
    ]
  ],
  "openalex": "W7221647087",
  "pdf_url": "https://europepmc.org/articles/PMC13685892?pdf=render",
  "pmcid": "PMC13685892",
  "pmid": "42909976",
  "published": "2026-10-13",
  "publisher": "Elsevier BV",
  "ris": "https://research.draconitic.com/paper/e3mp83m94jdz3.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:48Z",
      "native_id": "10.1016/j.eclinm.2026.104255",
      "source": "crossref",
      "url": "https://linkinghub.elsevier.com/retrieve/pii/S2589537026005080"
    },
    {
      "first_seen": "2026-10-30T12:20:10Z",
      "native_id": "MED:42909976",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42909976"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2735|Childhood Cancer Survivors' Quality of Life",
      "subfield": "reproductive-child"
    }
  ],
  "title": "Neighborhood disadvantages and longitudinal progression of multimorbidity among adult survivors of childhood cancer: a single-center St. Jude Lifetime Cohort Study in the U.S.",
  "title_text": "Neighborhood disadvantages and longitudinal progression of multimorbidity among adult survivors of childhood cancer: a single-center St. Jude Lifetime Cohort Study in the U.S.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:10Z",
  "url": "https://research.draconitic.com/paper/e3mp83m94jdz3",
  "venue": "eClinicalMedicine",
  "versions": []
}