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Background <p>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.</p> Methods <p>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.</p> Results <p>Among 16,261 participants, 11.6% (<i>n</i> = 1895) had cancer, 1.4% (<i>n</i> = 228) had cancer and PTSD, and 20.1% (<i>n </i>= 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 <i>p</i> &lt; 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 <i>p</i> &lt; 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 <i>p</i> &lt; 0.001).</p> Conclusion <p>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.</p> Implications for cancer survivors <p>Survivors with PTSD and high SDoH burden are especially vulnerable. Integrating trauma-informed care and SDoH screening strengthens survivorship equity and outcome.</p>

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Post-traumatic stress disorder and social determinants of health among individuals with cancer: association with healthcare utilization and outcomes in the All of Us Research Program

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月3日

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  • Sebastian O. Ekenze,
  • Odysseas P. Chatzipanagiotou,
  • Azza Sarfraz,
  • Qaidar Alizai,
  • Andrea Baldo,
  • Timothy M. Pawlik

摘要

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.