ArticleEClinicalMedicine2026
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.
Article in EClinicalMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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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