The impact of neighborhood disadvantage on health-related quality of life among African American and white cancer survivors
Following improvements in cancer survival rates quality of life (QOL) has become a key health outcome among cancer survivors. Neighborhood disadvantage has been shown to have a detrimental effect on health outcomes. To date, little is known regarding the influence of neighborhood disadvantage on the health-related QOL of cancer survivors. This study aimed to examine the associations between neighborhood disadvantage and health-related QOL among African American and White cancer survivors. Data were obtained from a retrospective survey study of African American (n=248) and White (n=244) cancer survivors. Physical (PHQOL) and mental health (MHQOL) QOL was measured by the Rand 36-Item Short Form. The neighborhood disadvantage index was created based four components, including prevalence of poverty, mother-only households, home ownership and the prevalence of college educated individuals living in the area. Covariates included demographic characteristics and clinical factors. To adjust the nesting effects of participants living in neighborhoods, a mixed effect linear regression model was conducted to test the association between neighborhood disadvantage and PHQOL and MHQOL after controlling for covariates. Regression results showed that patients living in more disadvantaged neighborhoods reported lower PHQOL than those in more advantaged places (β =−1.21, P=0.020). However, this relationship was not observed for MHQOL outcomes (β =−0.06, P=0.49). Race did not exert an independent influence on observed relationships. Study results contribute to a growing body of research documenting the detrimental effects of neighborhood disadvantage on cancer related outcomes.