Association Between Social Determinants of Health and Cancer Risk in Middle-Aged and Older Chinese Adults: Evidence From a Nationally Representative Cohort Study

Introduction This study examined the association between social determinants of health (SDHs) and cancer incidence in a nationally representative Chinese cohort. Methods We conducted a prospective cohort study using data from 12,335 participants in the China Health and Retirement Longitudinal Study (2011-2020). SDHs scores reflected favorable social conditions. Cox proportional hazards models estimated cancer risk across SDHs levels, with subgroup and sensitivity analyses. Results Higher SDHs scores were associated with a lower cancer risk (HR 0.69, 95% CI 0.51-0.95), particularly among men (HR 0.60, 95% CI 0.39-0.92), rural residents (HR 0.54, 95% CI 0.33-0.87), and individuals who smoked (HR 0.59, 95% CI 0.37-0.95) or drank alcohol (HR 0.47, 95% CI 0.27-0.82). No significant association was observed in participants with hypertension (HR 0.74, 95% CI 0.44-1.24) or hyperlipidemia (HR 0.85, 95% CI 0.33-2.18). Conclusions Favorable social conditions were linked to reduced cancer risk, emphasizing the need to improve social environments alongside lifestyle interventions.