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Relationships between social isolation, neighborhood poverty, and cancer mortality in a population-based study of US adults

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  • Andrea Fleisch Marcus
  • Alex H Illescas
  • Bernadette C Hohl
  • Adana A M Llanos

Abstract

Background: Social isolation is an important determinant of all-cause mortality, with evidence suggesting an association with cancer-specific mortality as well. In this study, we examined the associations between social isolation and neighborhood poverty (independently and jointly) on cancer mortality in a population-based sample of US adults. Methods: Using data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988–1994), NHANES III Linked Mortality File (through 2011) and 1990 Census, we estimated the relationship between social isolation and high neighborhood poverty and time-to-cancer death using multivariable-adjusted Cox proportional hazards models. We examined the associations of each factor independently and explored the multiplicative and additive interaction effects on cancer mortality risk and also analyzed these associations by sex. Results: Among 16 044 US adults with 17–23 years of follow-up, there were 1133 cancer deaths. Social isolation (HR 1.25, 95% CI: 1.01–1.54) and high neighborhood poverty (HR 1.31, 95% CI: 1.08–1.60) were associated with increased risk of cancer mortality adjusting for age, sex, and race/ethnicity; in sex-specific estimates this increase in risk was evident among females only (HR 1.39, 95% CI: 1.04–1.86). These associations were attenuated upon further adjustment for socioeconomic status. There was no evidence of joint effects of social isolation and high neighborhood poverty on cancer mortality overall or in the sex-stratified models. Conclusions: These findings suggest that social isolation and higher neighborhood poverty are independently associated with increased risk of cancer mortality, although there is no evidence to support our a priori hypothesis of a joint effect.

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  • Andrea Fleisch Marcus & Alex H Illescas & Bernadette C Hohl & Adana A M Llanos, 2017. "Relationships between social isolation, neighborhood poverty, and cancer mortality in a population-based study of US adults," PLOS ONE, Public Library of Science, vol. 12(3), pages 1-13, March.
    • Handle: RePEc:plo:pone00:0173370
    DOI: 10.1371/journal.pone.0173370
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    1. Mueller, Tom, 2020. "The poverty balancing equation: Expressing poverty of place as a population process," SocArXiv ws3gd, Center for Open Science.
    2. Jean C. Bikomeye & Sima Namin & Chima Anyanwu & Caitlin S. Rublee & Jamie Ferschinger & Ken Leinbach & Patricia Lindquist & August Hoppe & Lawrence Hoffman & Justin Hegarty & Dwayne Sperber & Kirsten , 2021. "Resilience and Equity in a Time of Crises: Investing in Public Urban Greenspace Is Now More Essential Than Ever in the US and Beyond," IJERPH, MDPI, vol. 18(16), pages 1-39, August.
    3. Carol Parise & Vincent Caggiano, 2018. "The influence of marital status and race/ethnicity on risk of mortality for triple negative breast cancer," PLOS ONE, Public Library of Science, vol. 13(4), pages 1-11, April.
    4. Katarzyna Orlewska & Andrzej Sliwczynski & Ewa Orlewska, 2018. "An ecological study of the link between the risk of most frequent types of cancer in Poland and socioeconomic variables," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 63(7), pages 777-786, September.

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