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.

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.