Examining the Intersection between Drivers of Disparities: Beyond Place – Social Determinants and Stress Reactivity in African American Breast Cancer Survivors

Abstract Responses to social stressors are important drivers of cancer risk and outcomes; however, current studies focus on neighborhood level SDOHs. We evaluated within-subject trajectories in stress reactivity (i.e., change in salivary cortisol) among 60 African American breast cancer patients and examined the moderating effects of social stressors on cortisol responses. SDOHs were obtained by self-report and were included in linear mixed-effects regression models that were generated for cortisol levels including time (primary regressor) adjusting for time-invariant covariates. Significant increases in cortisol levels were observed at 12- and 24-minutes post-Trier Social Stress Test tasks. Significant interactions between time and SDOHs on cortisol were identified. Higher and escalating stress reactivity was observed in patients with greater financial strain, social isolation, negative life events, and perceived stress. Social risk factors moderated stress reactivity; however, additional research is needed to understand the effects of physiological stress reactivity on tumor etiology and progression, especially among patients who have greater exposure to social stressors.