Leveraging Innovative Electronic Health Record Data to Characterize Social Determinants of Health Among Survivors of Cancer in Persistent Poverty Areas: Cross-Sectional Study

Clinical Snapshot

Key Findings

• P Value: Not applicable - descriptive study

• Effect Size: 19% of cancer survivors resided in persistent poverty areas (509/2672)

• Primary Outcome: Social determinant characteristics among cancer survivors in persistent poverty areas

• Nnt Or Sensitivity: Key findings: 15.8% lacked transportation, 4.2% had housing insecurity, 6.7% felt unsafe, 55.4% had Medicare coverage

• Confidence Interval: Not reported

Clinical Application

EHR-based screening approaches feasible but require systematic implementation and staff training Limited direct applicability due to different healthcare financing (Medicare vs private insurance mix), but social determinant screening principles relevant for Australian cancer services and could inform CanPlan initiatives Cancer survivors in socioeconomically disadvantaged areas requiring comprehensive social support assessment

Abstract

BACKGROUND: Residents in persistent poverty areas experience higher cancer mortality due to social determinants of health that negatively affect multiple factors, including health behaviors. OBJECTIVE: This study aimed to characterize demographic, clinical, and social determinant of health factors among survivors of cancer in persistent poverty areas using electronic health record (EHR) data-including an embedded social risk screener and natural language processing (NLP) of social work notes-to inform community-engaged adaptation of lifestyle interventions. METHODS: EHR data from a large multispecialty group practice were extracted for patients with cancer residing in zip codes inclusive of persistent poverty areas targeted for a health behavior intervention and receiving care between January 2018 and November 2023. Self-reported social determinant of health data were obtained using the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) and through NLP of social histories from a social work visit. RESULTS: We identified 2672 unique patients with cancer, of whom 578 (21.6%) had PRAPARE data and 1597 (59.8%) had social history data available for analysis. The most common cancers among survivors (n=1420, 53.1% female; n=1299, 48.6% Black individuals; mean age 65.2, SD 13.7 years) included breast (n=536, 20.1%), prostate (n=400, 15%), and lymphoid or hematopoietic (n=323, 12.1%) cancer. Among survivors in persistent poverty areas (n=509, 19%; all with a high Social Vulnerability Index), 34.6% (176/509) were single, 55.4% (282/509) had Medicare coverage (with only 73/509, 14.3% having private insurance), 36.5% (186/509) had obesity, 63.9% (325/509) had hypertension, and 31.2% (159/509) had diabetes. Of survivors in persistent poverty areas with PRAPARE data, 15.8% (19/120) lacked transportation, 4.2% (5/120) lived with housing insecurity, and 6.7% (8/120) felt unsafe where they lived. CONCLUSIONS: Innovative EHR and NLP approaches identified several socioeconomic and safety-related challenges along with opportunities for health behavior interventions to leverage Medicare coverage and target multiple comorbidities when adapting interventions for survivors of cancer living in persistent poverty areas.

References

1. 1.Tanaka, S., Rogers, L. Q., Zubkoff, L., Bateman, L., Demark-Wahnefried, W., Rocque, G., Bae, S., Pisu, M., Booth, J., & Howell, C. R. (2026). Leveraging innovative electronic health record data to characterize social determinants of health among survivors of cancer in persistent poverty areas: Cross-sectional study. JMIR Cancer. https://doi.org/10.2196/81054