Abstract C047: A latent class analysis of NHANES cancer survivors reveals disparities in cognitive impairment
Authors: Rao Rohit , Xie Hui , Wen Chi , Hsu Melinda L , Wang Qian 
Published: September 2024

Abstract
Cognitive impairment is an important factor affecting quality of life in the cancer survivor population. Specific treatments (radiation, chemo, targeted therapy), anxiety and pain can all contribute to decreased cognitive function. While analysis of disparities associated with cognitive impairment have been performed in the general population, similar studies have not yet been done in the adult cancer survivor population. This study had the following aims: a) to identify subgroups of cognitive impairment using a series of cognitive tests performed in 2011-2014 National Health and Nutrition Examination Survey (NHANES), and b) to identify factors associated with worse performing subgroups of cognitive impairment in an adult cancer survivor population. We performed a latent class analysis of the 2011-2014 NHANES cognitive questionnaire, which includes tests of word recall, digit symbol, and animal fluency tests: measures where poorer scores have been linked to dementia. The cohort comprised of 511 cancer survivors of age 55 and older (N=305). Among the cancer types represented in the cohort, Whites had relatively more melanoma, Hispanics had more breast cancer, and African Americans more prostate cancer. Using the poLCA package in R, we defined three latent classes corresponding to mild (CERAD Average 9.1/10 words after 3 trials, Animal Fluency of 19.7, Digit Substitution of 57.3), moderate (CERAD Average 7.7/10 words after 3 trials, Animal Fluency of 16.6, Digit Symbol of 46.4) and severe cognitive impairment (CERAD Average 5.6/10 words after 3 trials, Animal Fluency of 13.1, Digit Symbol of 31.7). We next performed multinomial regression to identify factors linked with moderate and severe cognitive impairment, examining age, sex, income, education, employment, alcohol/tobacco use and general health. We found that Nonwhite cancer survivors showed a significantly higher risk of moderate (OR 2.4 (1.0-5.4), p&lt;0.05) and severe cognitive impairment (OR 4.1(1.4-11.5), p&lt;0.01) compared to their White counterparts. An exploratory analysis of ethnicity also revealed a trend towards increased risk of moderate and severe cognitive impairment in African-Americans (OR 2.2/3.6), Hispanics (OR 1.8/ 3.9) and Multi-Racial/Other (OR 4.7/7.4) compared to their White counterparts. Female sex was associated with a significantly lower likelihood of moderate (OR 0.39 (0.19-0.83), p&lt;0.05) and severe cognitive impairment (OR 0.19 (0.07-0.53), p&lt;0.05). Other factors associated with severe cognitive impairment included being a college graduate (OR 0.18 (0.04-0.82), p&lt;0.05), age&gt;75 (OR 2.5 (1.1-5.6), p&lt;0.05), retired status (OR 5.8(1.5-22.8), p&lt;0.05), and unemployed status (OR 13.8 (1.6-116.8), p&lt;0.05). Our work suggests that within cancer survivors, non-white ethnicity is an independent contributor to severe cognitive impairment, even when controlling for other common socioeconomic factors. Future work will examine aspects of survivorship care that may drive these differences.
Citation Format: Cody Ramin, Jessica P Li, Kekoa Taparra, Geetanjali D Datta, Lene HS Veiga, Gretchen L Gierach, Robert Haile, Amy Berrington de Gonzalez, Jacqueline B Vo. A latent class analysis of NHANES cancer survivors reveals disparities in cognitive impairment [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C047.