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This study investigates the long-term effects of adverse social determinants of health on clinical outcomes in breast cancer survivors.

May 30, 2026

The long-term influence of adverse social determinants of health on clinical outcomes in breast cancer survivors: Insights from a propensity score–matched cohort study using federated electronic health records.

Key Points

This study investigates the long-term effects of adverse social determinants of health on clinical outcomes in breast cancer survivors.
Retrospective analysis of breast cancer patients using federated electronic health records from 88 healthcare organizations.
Cohort A included patients with adverse social determinants (n=21,947); Cohort B excluded these factors (n=1,031,237).
Outcomes were assessed via propensity score matching (1:1), resulting in balanced cohorts of 21,184 each.
Adverse social determinants were linked to significantly higher mortality risk (RR 1.186, 95% CI 1.132-1.243; p < 0.001).
Severe sepsis risk increased (RR 1.248, 95% CI 1.134-1.373; p < 0.001).
Malaise and fatigue were more prevalent (RR 1.048, 95% CI 1.001-1.097; p = 0.047), while lymphedema risk was lower (RR 0.713, 95% CI 0.663-0.768; p < 0.001).

Abstract

e12745 Background: Social determinants of health (SDOH), including housing instability, food insecurity, and socioeconomic challenges, are increasingly recognized as modulators of cancer outcomes. However, their long-term effects on breast cancer survivors remain underexplored. This study examines associations between adverse SDOH and clinical outcomes in breast cancer patients using real-world data. Methods: Utilizing the TriNetX federated network, we conducted a retrospective analysis to compare outcomes on adult breast cancer patients (ICD-10-CM: C50) from 88 healthcare organizations. Cohort A (BreastSDOH; n = 21, 947) comprised patients with documented adverse SDOH (e. g. , homelessness Z59. 0, food insecurity Z59. 41), while Cohort B (BreastₙonSDOH; n = 1, 031, 237) excluded such factors. Propensity score matching (1: 1) balanced cohorts (n = 21, 184 each) on demographics, comorbidities, and BMI. Outcomes assessed starting 1-day post-index event (first breast cancer or SDOH diagnosis), included mortality, severe sepsis, lymphedema, pain, malaise/fatigue, memory loss, and angiosarcoma. Analyses included measures of association, Kaplan-Meier survival, and instance counts, with statistical significance at p < 0. 05. Results: Adverse SDOH were associated with significantly higher risks and hazards for several outcomes. Mortality risk was elevated (15. 9% vs. 13. 4%; risk ratio RR 1. 186, 95% CI 1. 132-1. 243; p < 0. 001), with a hazard ratio (HR) of 1. 849 (95% CI 1. 755-1. 948; p < 0. 001). Severe sepsis showed increased risk (4. 5% vs. 3. 6%; RR 1. 248, 95% CI 1. 134-1. 373; p < 0. 001; HR 1. 872, 95% CI 1. 695-2. 068; p < 0. 001). Malaise and fatigue (23. 1% vs. 22. 0%; RR 1. 048, 95% CI 1. 001-1. 097; p = 0. 047; HR 1. 520, 95% CI 1. 441-1. 603; p < 0. 001) and memory loss (13. 5% vs. 11. 7%; RR 1. 161, 95% CI 1. 099-1. 228; p < 0. 001; HR 1. 895, 95% CI 1. 783-2. 014; p < 0. 001) were also more prevalent. Conversely, lymphedema (5. 9% vs. 8. 3%; RR 0. 713, 95% CI 0. 663-0. 768; p < 0. 001) and angiosarcoma (19. 1% vs. 38. 4%; RR 0. 497, 95% CI 0. 475-0. 521; p < 0. 001; HR 0. 505, 95% CI 0. 479-0. 532; p < 0. 001) risks were lower, potentially reflecting differential healthcare access or documentation biases. Pain exhibited mixed findings, with marginally lower risk (19. 3% vs. 20. 4%; RR 0. 944, 95% CI 0. 899-0. 991; p = 0. 021) but higher hazard (HR 1. 508, 95% CI 1. 426-1. 594; p < 0. 001), suggesting accelerated onset in the SDOH group. Conclusions: Adverse SDOH exacerbate long-term risks of mortality, sepsis, and neurocognitive symptoms in breast cancer survivors, underscoring the need for integrated social support interventions. Lower risks for certain treatment-related outcomes may indicate barriers to care or underreporting. These findings call for SDOH screening and mitigation strategies in oncology to improve equitable outcomes.

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