Understanding the influence of social determinants of health on symptom reporting in pediatric cancer

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2025-08-01 DOI:10.1111/jrh.70071

Micah A. Skeens PhD, Adelaide Booze BA, Mark Ranalli MD, Anna Olsavsky PhD

{"title":"Understanding the influence of social determinants of health on symptom reporting in pediatric cancer","authors":"Micah A. Skeens PhD, Adelaide Booze BA, Mark Ranalli MD, Anna Olsavsky PhD","doi":"10.1111/jrh.70071","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Children with cancer experience significant symptom burden, worsened by social deprivation. This study examines social determinants of health, including Appalachian residency, influence on symptom burden.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Caregiver-child dyads were recruited within 1 year of cancer treatment. Addresses were coded for social determinants of health (SDOH) measures: Area Deprivation Index (ADI), rurality, medically underserved areas (MUA), and Appalachian residency. Total child symptom scores (0–31) were calculated for dyad reports using the Memorial Symptom Assessment Scale. Provider matching symptom reports were extracted from electronic medical records. Descriptive statistics and correlations examined associations between child, caregiver, and provider symptom reports and SDOH. Significant correlations informed three multiple linear regression models examining SDOH predictors of child symptoms by reporter.</p>\n </section>\n \n <section>\n \n <h3> Findings</h3>\n \n <p>Fifty-five caregiver-child dyads were recruited. Caregivers were 65.5% female and 87.3% White. Children were 50.9% male, 85% White, an average of 12 years old, 30.9% rural, and 20.0% Appalachian. ADI scores (<i>M</i> = 4.22) indicated moderate disadvantage, and 14.5% were medically underserved. On average, children reported 8.61 symptoms, while caregivers reported 7.15, and providers recorded 1.87 child symptoms. For children, a bivariate association and significant regression model revealed Appalachian children experienced a higher number of symptoms. For caregivers, bivariate associations indicated a higher ADI was associated with more symptoms. For providers, bivariate associations revealed higher symptoms were associated with rurality, MUA, and Appalachian residency, though only Appalachian residency remained significant in the regression model.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Results suggest Appalachian residency is associated with higher symptom burden for children with cancer. Findings support culturally sensitive care to minimize symptom burden.</p>\n </section>\n </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 3","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70071","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Rural Health","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jrh.70071","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Children with cancer experience significant symptom burden, worsened by social deprivation. This study examines social determinants of health, including Appalachian residency, influence on symptom burden.

Methods

Caregiver-child dyads were recruited within 1 year of cancer treatment. Addresses were coded for social determinants of health (SDOH) measures: Area Deprivation Index (ADI), rurality, medically underserved areas (MUA), and Appalachian residency. Total child symptom scores (0–31) were calculated for dyad reports using the Memorial Symptom Assessment Scale. Provider matching symptom reports were extracted from electronic medical records. Descriptive statistics and correlations examined associations between child, caregiver, and provider symptom reports and SDOH. Significant correlations informed three multiple linear regression models examining SDOH predictors of child symptoms by reporter.

Findings

Fifty-five caregiver-child dyads were recruited. Caregivers were 65.5% female and 87.3% White. Children were 50.9% male, 85% White, an average of 12 years old, 30.9% rural, and 20.0% Appalachian. ADI scores (M = 4.22) indicated moderate disadvantage, and 14.5% were medically underserved. On average, children reported 8.61 symptoms, while caregivers reported 7.15, and providers recorded 1.87 child symptoms. For children, a bivariate association and significant regression model revealed Appalachian children experienced a higher number of symptoms. For caregivers, bivariate associations indicated a higher ADI was associated with more symptoms. For providers, bivariate associations revealed higher symptoms were associated with rurality, MUA, and Appalachian residency, though only Appalachian residency remained significant in the regression model.

Conclusions

Results suggest Appalachian residency is associated with higher symptom burden for children with cancer. Findings support culturally sensitive care to minimize symptom burden.

查看原文本刊更多论文

了解健康的社会决定因素对儿童癌症症状报告的影响

目的癌症患儿有明显的症状负担，社会剥夺加重了症状负担。本研究探讨健康的社会决定因素，包括阿巴拉契亚居住，对症状负担的影响。方法在癌症治疗1年内招募照顾者-儿童二人组。根据健康的社会决定因素（SDOH）措施对地址进行编码：地区剥夺指数（ADI）、乡村性、医疗服务不足地区（MUA）和阿巴拉契亚居民。使用记忆症状评估量表计算儿童症状总分（0-31分）。从电子医疗记录中提取提供者匹配症状报告。描述性统计和相关性检验了儿童、照料者和提供者症状报告与SDOH之间的关系。报告者通过三个多元线性回归模型检验儿童症状的SDOH预测因子，发现了显著的相关性。研究结果：共招募了55对照顾者-儿童的夫妇。照顾者中女性占65.5%，白人占87.3%。儿童中男性占50.9%，白人占85%，平均12岁，农村占30.9%，阿巴拉契亚地区占20.0%。ADI评分（M = 4.22）显示中度劣势，14.5%的患者医疗服务不足。平均而言，儿童报告了8.61种症状，而护理人员报告了7.15种，提供者记录了1.87种儿童症状。对于儿童，双变量关联和显著回归模型显示阿巴拉契亚儿童经历了更多的症状。对于护理人员，双变量关联表明较高的ADI与更多的症状相关。对于医疗服务提供者而言，双变量关联显示较高的症状与乡村性、MUA和阿巴拉契亚地区居住有关，尽管只有阿巴拉契亚地区居住在回归模型中仍然显著。结论阿巴拉契亚地区居住与癌症儿童较高的症状负担相关。研究结果支持文化敏感性护理以减少症状负担。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.