美国癌症幸存者的死亡率存在种族和民族差异，健康社会决定因素 (SDoH) 可能对这些差异产生重大影响。一项基于人群的队列研究，针对美国成年癌症幸存者的全国代表性样本进行了研究纳入1999年至2018年全国健康与营养调查。在每个调查周期中，使用标准化问卷自行报告社会人口特征和 SDoH。 SDoH 按种族进行检查，并估计其与主要结局的关联，其中包括全因死亡率和癌症特异性死亡率。我们进行了多重中介分析，以评估每种不利的 SDoH 对全因死亡率和癌症特异性死亡率的种族差异的影响。在 5163 名癌症幸存者中（2724 名 [57.7%] 女性和 3580 名 [69.3%] 非西班牙裔白人），只有 881 人 (24.9%) 没有报告不利的 SDoH。在长达 249 个月（中位数 81 个月）的随访期间，记录了 1964 例死亡（癌症 624 例；心血管疾病 529 例；其他原因 811 例）。在非西班牙裔黑人和白人癌症幸存者之间观察到全因死亡率和癌症特异性死亡率的差异。失业、较低的经济地位、教育程度低于高中、政府或没有私人保险、租房或其他安排以及社会孤立与较差的总体生存率显着且独立相关。失业、较低的经济地位和社会孤立与癌症特异性死亡率显着相关。与没有不良 SDoH 的患者相比，累积不良 SDoH 次数的患者全因死亡风险逐渐增加（1 个不利 SDoH：风险比 [HR] = 1.54，95% CI 1.25-1.89；2 个不利 SDoH） ：HR = 1.81，95% CI 1.46-2.24；3 个不利 SDoH：HR = 2.42，95% CI 1.97-2.97；4 个不利 SDoH：HR = 3.22，95% CI 2.48-4.19；5 个不利 SDoH ：HR = 3.99， 95% CI 2.99-5.33；6 个不利的 SDoH：HR = 6.34 95% CI 4.51-8.90）。癌症特异性死亡率也存在类似的趋势。在这项针对美国癌症幸存者全国代表性样本的队列研究中，更多不利的 SDoH 与各种原因和癌症死亡风险的增加相关。不利的 SDoH 水平是全因死亡率和癌症特异性死亡率的关键风险因素，也是美国癌症幸存者种族全因死亡率差异的根本原因。© 2024。作者。

Racial and ethnic disparities in mortality persist among US cancer survivors, with social determinants of health (SDoH) may have a significant impact on these disparities.A population-based cohort study of a nationally representative sample of adult cancer survivors, who participated in the US National Health and Nutrition Examination Survey from 1999 to 2018 was included. Sociodemographic characteristics and SDoH were self-reported using standardized questionnaires in each survey cycle. The SDoH was examined by race and estimated for associations with primary outcomes, which included all-cause and cancer-specific mortality. Multiple mediation analysis was performed to assess the contribution of each unfavorable SDoH to racial disparities to all-cause and cancer-specific mortality.Among 5163 cancer survivors (2724 [57.7%] females and 3580 [69.3%] non-Hispanic White individuals), only 881 (24.9%) did not report an unfavorable SDoH. During the follow-up period of up to 249 months (median 81 months), 1964 deaths were recorded (cancer, 624; cardiovascular, 529; other causes, 811). Disparities in all-cause and cancer-specific mortality were observed between non-Hispanic Black and White cancer survivors. Unemployment, lower economic status, education less than high school, government or no private insurance, renting a home or other arrangements, and social isolation were significantly and independently associated with worse overall survival. Unemployment, lower economic status, and social isolation were significantly associated with cancer-specific mortality. Compared to patients without an unfavorable SDoH, the risk of all-cause mortality was gradually increased in those with a cumulative number of unfavorable SDoHs (1 unfavorable SDoH: hazard ratio [HR] = 1.54, 95% CI 1.25-1.89; 2 unfavorable SDoHs: HR = 1.81, 95% CI 1.46-2.24; 3 unfavorable SDoHs: HR = 2.42, 95% CI 1.97-2.97; 4 unfavorable SDoHs: HR = 3.22, 95% CI 2.48-4.19; 5 unfavorable SDoHs: HR = 3.99, 95% CI 2.99-5.33; 6 unfavorable SDoHs: HR = 6.34 95% CI 4.51-8.90). A similar trend existed for cancer-specific mortality.In this cohort study of a nationally representative sample of US cancer survivors, a greater number of unfavorable SDoH was associated with increased risks of mortality from all causes and cancer. Unfavorable SDoH levels were critical risk factors for all-cause and cancer-specific mortality, as well as the underlying cause of racial all-cause mortality disparities among US cancer survivors.© 2024. The Author(s).