Abstract 974: Social determinants in healthcare utilization among women diagnosed with cervical cancer: data from <i>The All of Us Research Program</i>
Authors: Brenda C. Torres-Velásquez, Josué Pérez-Santiago, Natalie Alamo-Rodríguez, Julie Dutil, Vivian Colón-López
Journal: Cancer Research (2025)

Abstract Despite significant declines in cervical cancer incidence and mortality, disparities persist, particularly among underserved populations. This study aims to investigate how social determinants of health contribute to the barriers faced by women diagnosed with cervical cancer, affecting healthcare utilization. Utilizing the All of Us Research Program database, we analyzed a cohort of women diagnosed with malignant tumors of the cervix, including carcinoma in situ, using ICD-10-CM codes C53 and D06. Participants, all identifying as women, completed validated surveys assessing overall health, healthcare access and utilization, personal and family health history, and social determinants of health. Univariate and multivariate logistic regression models were conducted to assess social determinants of health in relation to healthcare access. Key dependent variables included delays in seeking healthcare due to limited time-off, caregiving responsibilities, inadequate transportation, and financial constraints such as difficulties affording medications or copayments. Data was analyzed using RStudio Cloud Environment within All of Us Workbench. Among the 1, 310 cervical cancer patients analyzed, 299 (22.8%) identified themselves as Hispanics, 670 (51.1%) as non-Hispanic White, 265 (20.3%) as non-Hispanic Black, and 76 (5.8%) as other or unknown. Educational attainment was high, with 852 (65%) attending or having completed college. Most participants (95%) had some form of insurance; however, (43.7%) reported annual earnings below $50, 000. Participants earning between $25, 000 and $50, 000 were 3.6 times more likely [OR=3.6; 95% CI: 1.2-15.8] to delay seeking healthcare due to time-off issues compared to those earning $200, 000 or more. Participants earning $25, 000 or less compared to those earning $200, 000 or more identified transportation access as a significant barrier to healthcare (OR=6.3 [95% CI: 1.8-40.1]), still were 4.2 times more likely [95% CI: 1.1-17.3] to seek advice from a general doctor. This OR slightly decreased to 4.1 [95% CI: 1.1-17.0] when adjusting for insurance coverage awareness, to 3.8 [95% CI: 1.01-15.5] when considering the nervous emotional state, and returned to 4.2 [ 95%CI 1.1-17.4] when perceiving easily understandable health information. Income and transportation are critical factors influencing healthcare-seeking behavior among low-income women diagnosed with cervical cancer; however, they do not act in isolation. Barriers related to social determinants significantly affect their ability to maintain appropriate follow-up care. Interestingly, race and ethnicity did not emerge as significant disparities in this cohort. Further investigation into insurance specifics, family dynamics, cultural beliefs, and other social determinants is essential for achieving equity in healthcare access for women with cervical cancer. Citation Format: Brenda C. Torres-Velásquez, Josué Pérez-Santiago, Natalie Alamo-Rodríguez, Julie Dutil, Vivian Colón-López. Social determinants in healthcare utilization among women diagnosed with cervical cancer: data from The All of Us Research Program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 974.