# Social Risk Prevalence in Adolescent and Young Adult Patients With and Without a History of Cancer

## TL;DR

This study finds that about one-third of adolescent and young adult patients, whether they have cancer or not, face social risks like financial hardship, highlighting the need for routine screening to improve equitable care.

## Contribution

The study is one of the first to compare social risk prevalence in adolescent and young adult patients with and without cancer using a large, real-world dataset.

## Key findings

- 30% of patients with cancer and 33% without cancer reported at least one social risk, with financial hardship being the most common.
- Patients aged 20-29 years and those with multiple comorbidities or prior financial assistance had higher odds of social risks.
- Female patients, those with commercial insurance, and residents of less-deprived areas had lower odds of social risks.

## Abstract

What is the prevalence of social risks among adolescent and young adult patients with and without cancer?

In this cross-sectional study of 96 127 patients, 30% of those with cancer and 33% without cancer reported at least 1 social risk, with financial hardship being most common. Social risk was higher among patients aged 20 to 29 years and those with multiple comorbidities, prior medical financial assistance, or identifying as Hispanic, and a lower risk was observed among female patients, those with commercial insurance and longer health system membership, and residents of less-deprived areas.

These findings reveal the magnitude of social risks among adolescent and young adult patients and emphasize the importance of routine screening to reduce disparities and promote equitable care.

This cross-sectional study assesses the prevalence of social risks among adolescents and young adults (AYAs) with and without a history of cancer within an integrated US health system.

Health care practices rarely assess or assist patients with social risks, thereby missing a crucial aspect of medical care.

To assess the prevalence of social risks among adolescents and young adults (AYAs) with and without a history of cancer within an integrated US health system.

This cross-sectional study analyzed data from AYA (aged 15-40 years) members of Kaiser Permanente Northwest (Oregon and Washington) who completed a social risk screener between January 1, 2022, and December 31, 2024.

Cancer history identified via electronic health records.

Four patient-reported social risk domains (financial hardship, food insecurity, housing instability, and transportation difficulties) were assessed as binary (yes or no) indicators. A composite binary variable was created to reflect the presence or absence of any social risk. Descriptive statistics and multivariable logistic regression models were used to compare prevalence and identify associated factors.

Of 96 127 AYA patients (6.2% aged 15-19 years, 37.4% aged 20-29 years, and 56.4% aged 30 to 40 years; 63.3% female; 13.0% identifying as Hispanic, 63.4% as non-Hispanic White, and 23.6% as non-Hispanic other race and ethnicity), 1239 (1.3%) had a history of cancer, and these patients compared with those without cancer were older (aged 30-40 years, 82.6% vs 56.0%), were more likely to be female (81.4% vs 63.1%) and non-Hispanic White (74.3% vs 63.3%), and had more comorbidities (8.8% vs 3.9%). No significant differences were observed in household income, education level, or neighborhood deprivation between groups. Thirty percent of patients with cancer and 33% without cancer reported experiencing at least 1 social risk. Financial hardship was the most common issue, followed by food insecurity, housing instability, and transportation difficulties. Higher odds of social risks were observed among patients aged 20 to 29 years (odds ratio [OR], 1.58 [95% CI, 1.54-1.63]) and those with 3 or more comorbidities (OR, 1.79 [95% CI, 1.67-1.92]), prior medical financial assistance (OR, 2.10 [95% CI 1.99-2.22]), or identifying as Hispanic (OR, 1.14 [95% CI, 1.09-1.19]). Lower odds were found among female patients (OR, 0.91 [95% CI, 0.88-0.94]), commercially insured patients (OR, 0.32 [95% CI, 0.31-0.34]), longer Kaiser Permanente Northwest membership (OR, 0.99 [95% CI, 0.99-0.99]), and residents of less-deprived neighborhoods (neighborhood deprivation index [NDI] quartile 1: OR, 0.65 [95% CI, 0.62-0.67]; NDI quartile 2: OR, 0.74 [95% CI, 0.71-0.77]; NDI quartile 3: OR, 0.81; 95% CI, 0.78-0.84).

This cross-sectional study found that regardless of cancer history, AYA patients may experience a high burden of social risks. These findings support the need to routinely assess and address social risks in AYA populations to improve equity in health care. Future research should investigate the association of social risks with health care use and long-term outcomes.