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.
Abstract
Background
The 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
In 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
Survivors 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
SDOH 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
U.S. National Cancer Institute.
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BibTeX
@article{choi2026neighborhood,
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.}},
author = {Jaesung Choi and Madeline R. Horan and Sedigheh Mirzaei and Deo Kumar Srivastava and Nickhill Bhakta and Stephanie B. Dixon and Matthew J. Ehrhardt and Carmen L. Wilson and Angela Delaney and Yikyung Park and Daniel A. Mulrooney and Heather M. Brandt and Kirsten K. Ness and Gregory T. Armstrong and Melissa M. Hudson and I-Chan Huang},
journal = {eClinicalMedicine},
year = {2026},
month = oct,
doi = {10.1016/j.eclinm.2026.104255},
url = {https://linkinghub.elsevier.com/retrieve/pii/S2589537026005080},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - 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.
AU - Jaesung Choi
AU - Madeline R. Horan
AU - Sedigheh Mirzaei
AU - Deo Kumar Srivastava
AU - Nickhill Bhakta
AU - Stephanie B. Dixon
AU - Matthew J. Ehrhardt
AU - Carmen L. Wilson
AU - Angela Delaney
AU - Yikyung Park
AU - Daniel A. Mulrooney
AU - Heather M. Brandt
AU - Kirsten K. Ness
AU - Gregory T. Armstrong
AU - Melissa M. Hudson
AU - I-Chan Huang
PY - 2026
DA - 2026/10/13
JO - eClinicalMedicine
DO - 10.1016/j.eclinm.2026.104255
UR - https://linkinghub.elsevier.com/retrieve/pii/S2589537026005080
AB - Background The 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 In 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 Survivors 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 SDOH 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 U.S. National Cancer Institute.
SN - 2589-5370
ER -