Current, persistent, and low-poverty area residence and social risks among Black cancer survivors

Persistent area-level poverty may be associated with long-term social and economic disinvestment, which can contribute to social risks and financial difficulties for individuals. This study examines the associations between census tract poverty and the prevalence of social risks and financial hardship among Black cancer survivors.

Data were used from 4066 participants in the population-based Detroit Research on Cancer Survivors cohort. Census tract poverty was categorized as persistent (≥20% of residents in poverty for 30+ years), current (≥20% currently in poverty), and low (<20% in poverty). Participants self-reported social risks related to food, housing, utilities, access to care, and safety as well as material and behavioral financial hardship. Prevalence ratios and 95% confidence intervals (CIs) were estimated with modified Poisson models controlling for sociodemographic and cancer-related factors.

Overall, 36% of participants reported any social risks. The prevalence was higher in persistent (45%) relative to both current (40%) and low-poverty areas (25%). The prevalence of each social risk and of behavioral financial hardship was higher in current and persistent versus low-poverty areas in unadjusted models but most attenuated in adjusted models. The adjusted prevalence of any social risk was 21% higher in both persistent (95% CI, 7%-37%) and current (95% CI, 7%-36%) compared with low-poverty areas. Area poverty was not associated with financial hardship in adjusted models.

Living in current but not persistent or persistent high-poverty areas is associated with a higher prevalence of social risks. Residents of high-poverty areas may represent a priority population for screening and intervention.