Abstract 1917: Socioeconomic barriers and their association with healthcare delays by nativity among cancer survivors from the All of Us Cohort
Authors: Arizpe Angel , Navarro Stephanie , Ochoa Carol Y. , Farias Albert J. 
Published: April 2023

Abstract
Background: Healthcare delays (HcD) have a negative impact on mortality and the overall health and quality of life of cancer survivors (CS). Socioeconomic (SES) barriers (hereinafter as barriers) are associated with inadequate healthcare access and are exacerbated by differences in nativity status (foreign-born vs US-born). Since foreign-born individuals may experience greater barriers than their US-born counterparts, it is important to assess the association of SES barriers with HcD in a sample of US CS and explore nativity differences.
Methods: This study analyzed CS survey data collected from May 2018 to April 2021 from the “All of Us” research program. HcD was assessed by creating a binary indicator where those that responded yes to delaying care for any reason (financial, social, and accessibility), were considered to have experienced HcD, and those who responded no delays of care for all aspects were considered to have not experienced HcD. Barriers were assessed by creating a composite measure of SES (i.e., insurance, employment, education, income, and housing) with scores ranging from 0 (no barriers) to 3+ (3 or more barriers). Multivariable (sex, race, marital status, cancer type, nativity) logistic regression models tested the associations between 1) barriers and HcD and 2) explored whether this relationship varied by nativity.
Results: The median age in our sample was 64 years (IQR=17.04), with a higher proportion of White ethnicity/race (82%) and females (66%) participants. Compared to US-born (n=9206) a greater proportion of foreign-born individuals (n=815) reported more HcD (31% vs 35%) and 3+ barriers (10% vs 15%). Multivariable analyses showed that CS who experienced 2 or 3+ barriers had 1.64 (95%CI: 1.43,1.89) and 2.15 (95%CI: 1.83,2.53) times the odds of experiencing HcD compared to those with no barriers, respectively. These associations varied by nativity (LRT pinteraction=0.03), showing that for every 1 additional barrier, the odds of HcD were more than 2 times greater for foreign-born than US-born (OR=1.65, 95%CI:1.39,1.98, ptrend&lt;0.001 vs OR=1.27, 95%CI:1.21,1.34, ptrend&lt;0.001).
Conclusion: We found that SES-related barriers have a significantly negative impact on HcD among foreign- and US-born cancer survivors, with a greater effect among foreign-born individuals. Our study underscores that if health systems and practices want to achieve health equity, more emphasis should be placed on addressing the social determinants of health.
Citation Format: Angel Arizpe, Stephanie Navarro, Carol Y. Ochoa, Albert J. Farias. Socioeconomic barriers and their association with healthcare delays by nativity among cancer survivors from the All of Us Cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1917.