Abstract：
We investigated the influence of social determinants of health (SDOH), healthcare services, and health behaviors on mental and physical health outcomes of cancer patients between the first winter and the following post-vaccine summer of the COVID-19 pandemic. A three-wave online survey of individuals diagnosed with incident cancer between January 2019 and January 2020 was conducted between November of 2020 and August of 2021 in northeast Ohio. Descriptive analysis and mixed-effect regression analyses were performed. A total of 322 newly diagnosed cancer patients, with 40 African Americans and 282 Whites (215 from metropolitan areas and 67 nonmetropolitan) responded to the survey questions. In Wave 3 ending in August 2021, the survey respondents reported significantly reduced depression (p = .019) on the Hamilton Depression Rating Scale and improved global health (p = .036) on PROMIS. With age, comorbidity, and other demographic and medical variables controlled in the analyses, the feeling of loneliness (p < .001) and crowded living space (p = .001, p = .015) were the two most prominent factors associated with depression, irritability, and poor global health at baseline, with the lowest p values and persistent effect. Self-efficacy of taking preventive measures was associated with reduced depression (p = .001) and improved global health (p = .029). Increasing access to medicine (p < .01) and satisfaction with telehealth appointments (p < .01) were significantly associated with better global health and reduced irritability. Respondents who had private health insurance reported better health than those that had Medicare coverage only (p < .05). This longitudinal, observational study demonstrated the impact of SDOH on health outcomes of cancer patients. Substandard living conditions resulting in loneliness and crowdedness, quality of medical care (e.g., quality telehealth and access to medicine), and personal behaviors (e.g., self-efficacy) were significantly associated with health outcomes in newly diagnosed cancer patients during the pandemic and should be given adequate consideration for the purpose of improving clinical care.
摘要：
我们调查了健康的社会决定因素(SDOH)的影响，医疗保健服务,以及健康行为对COVID-19大流行的第一个冬季至随后的疫苗后夏季之间癌症患者身心健康结果的影响。在2020年11月至2021年8月之间，在俄亥俄州东北部进行了一项针对2019年1月至2020年1月期间被诊断患有癌症的个人的三波在线调查。进行描述性分析和混合效应回归分析。共有322名新诊断的癌症患者，有40名非洲裔美国人和282名白人（215名来自大都市地区和67名非大都市地区）回答了调查问题。在2021年8月结束的第3波中，调查受访者报告了汉密尔顿抑郁量表上的抑郁显着减少（p=.019），并在PROMIS上改善了全球健康状况（p=.036）。随着年龄的增长,合并症，以及分析中控制的其他人口统计学和医学变量，孤独感（p<.001）和拥挤的生活空间（p=.001，p=.015）是与抑郁相关的两个最突出的因素，烦躁，基线时全球健康状况不佳，p值最低，效果持久。采取预防措施的自我效能感与抑郁降低(p=.001)和全球健康改善(p=.029)相关。获得医疗服务的增加（p<.01）和对远程医疗预约的满意度（p<.01）与更好的全球健康状况和减少的易怒性显着相关。有私人健康保险的受访者报告说，他们的健康状况比仅有医疗保险的受访者更好(p<.05)。这个纵向，观察性研究表明SDOH对癌症患者健康结局的影响.生活条件不达标,造成孤独和拥挤,医疗质量(例如，高质量的远程医疗和获得药物)，和个人行为(例如，自我效能）与大流行期间新诊断的癌症患者的健康结果显着相关，应充分考虑以改善临床护理。
