Abstract Background Individual effect of posttraumatic stress disorder (PTSD) and social determinants of health (SDoH) on healthcare utilization and well-being among cancer patients remains unclear. We sought to assess independent and combined effects of these factors on healthcare utilization and self-reported well-being. Methods All of Us Research Program was used to identify participants with cancer and/or PTSD, as well as individuals with neither. SDoH burden, healthcare utilization, and well-being were assessed relative to PTSD on multivariable logistic regression adjusting for sociodemographic factors. Results Among 16,261 participants, 11.6% ( n = 1895) had cancer, 1.4% ( n = 228) had cancer and PTSD, and 20.1% ( n = 3281) had PTSD alone. PTSD was associated with higher odds of emergency room visits (aOR 4.16, 95% CI 3.80–4.55), poor mental (aOR 3.77, 95% CI 3.43–4.14), and emotional health (aOR 3.76, 95% CI 3.41–4.16) (all p < 0.001). High SDoH burden independently predicted increased inpatient and emergency visits (aOR 1.24, 95% CI 1.13–1.36), as well as greater risk of poor quality of life (aOR 3.71, 95% CI 3.20–4.32) (all p < 0.001). Cancer patients with PTSD and high SDoH burden had substantially greater odds of poor mental health (aOR 10.92, 95% CI 9.33–12.77) and poor emotional health (aOR 12.20, 95% CI 10.33–14.41) (all p < 0.001). Conclusion Cancer, PTSD, and high SDoH burden were independently associated with greater healthcare use and worse well-being with combined exposures amplifying risk among cancer survivors. Implications for cancer survivors Survivors with PTSD and high SDoH burden are especially vulnerable. Integrating trauma-informed care and SDoH screening strengthens survivorship equity and outcome.
Ezomike et al. (Tue,) studied this question.
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