Social Risk Burden among US Cancer Survivors across Adulthood: Evidence from the 2022-2023 BRFSS

Cancer can exacerbate social vulnerabilities, undermining follow-up care, screening, and survivorship. Yet, nationally representative data on multiple social risks among survivors are limited. This study estimated the prevalence of social risks among cancer survivors relative to adults without a cancer history. We analyzed 2022 to 2023 Behavioral Risk Factor Surveillance System data (n = 472,531; weighted n = 265.6 million). Seven social risks were assessed: food insecurity (two items), housing insecurity, utility insecurity, employment insecurity, transportation insecurity, and cost-related barrier to care. We estimated prevalence and absolute differences (AD) by cancer history, stratified by age group. Among young adults (18-39), analyses were further stratified by Medicaid expansion status, race and ethnicity, and sex. Overall, 8.7% of adults reported a history of cancer. Survivors had higher prevalence of social risks in young adulthood, attenuated differences in middle age (40-64 years), and absent or reversed differences in older adulthood (65+). Among young adult survivors, ADs were larger in non-Medicaid expansion states for Supplemental Nutrition Assistance Program participation, housing and utility insecurity, and cost-related barrier to care. ADs were generally larger among non-Hispanic White adults, although racially and ethnically minoritized groups experienced higher prevalence across all social risks. ADs were also larger among males than females. Young adult cancer survivors bear the highest burden of social risks, with notable differences by Medicaid expansion status and demographic factors such as race and ethnicity and sex.

Age-stratified, population-based comparisons of social risks between cancer survivors and adults without a cancer history provide actionable baselines for survivorship care and policy design, particularly for younger survivors.