Abstract 3581: Psychosocial factors associated with lung cancer incidence and survival among individuals with low income in the Southeastern U.S.
Authors: Anna Junkins, Jennifer Richmond, Douglas DeMoulin, Xijing Han, Heather Munro, Martha J. Shrubsole, Wei Zheng, Xiao Ou Shu, Melinda C. Aldrich
Journal: Cancer Research (2025)

Background: Lung cancer is the leading cause of cancer-related mortality in the U.S. and significant racial inequities exist. Psychosocial factors, including stressful life experiences, have been linked to increased incidence and poorer outcomes. The purpose of this study was to identify psychosocial factors associated with lung cancer incidence and survival among a low-income, racially diverse population in the U.S. South. Methods: We utilized data from the Southern Community Cohort Study (SCCS), a large, prospective study across 12 Southeastern states, enrolling participants from 2002-2009, to examine psychosocial factors and lung cancer incidence and survival. Incident cancers and deaths were identified by linkage with state cancer registries and the National Death Index, respectively. Individual-level social, behavioral, and medical history information was ascertained at baseline via questionnaire. We examined depression, spirituality, attendance at faith-based services, social support, and use of anti-depressant/anxiety medication. We also analyzed data from a subset of participants who responded to psychosocial questions collected on a follow-up survey. We used Cox regression analyses to identify factors associated with lung cancer incidence and survival overall and by race. Results: Among 74,295 SCCS participants, approximately 69.8% self-reported as Black persons, 58.4% female, and 56.3% had an annual household income below $15,000. There were 1,569 incident lung cancer cases identified, of whom, almost half (49.2%) were diagnosed at distant stage. Overall, lower spirituality was associated with a reduced risk of lung cancer. Among Black participants, identifying as “fairly” vs. “very” spiritual was associated with a 15% lower risk (HR: 0.85; 95% CI: 0.74-0.97); a similar pattern was observed among White participants but was not statistically significant. Similar patterns were observed with mortality. In subset analyses among 367 participants with lung cancer, depression and less frequent attendance at faith-based services were associated with greater mortality. Among Black participants, those with depression had 2.75-fold greater mortality (95% CI:1.11-6.84) compared to those without depression, and those who attended faith-based services at least once per week had 50% lower mortality compared to those who attended less than once per week (HR: 0.50; 95% CI: 0.30-0.83). Among White participants, identifying as “slightly/not at all” vs. “very” spiritual was associated with 4.31-fold greater mortality (95% CI: 1.47-12.66). Conclusions: Psychosocial factors and spirituality may play a role in inequities observed in lung cancer outcomes. Future research should investigate how psychosocial factors may impact lung cancer outcomes. Citation Format: Anna Junkins, Jennifer Richmond, Douglas DeMoulin, Xijing Han, Heather Munro, Martha J. Shrubsole, Wei Zheng, Xiao Ou Shu, Melinda C. Aldrich. Psychosocial factors associated with lung cancer incidence and survival among individuals with low income in the Southeastern U.S [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 3581.