Associations of socioeconomic status and malnutrition with survival in adults with cancer in the UK Biobank: A prospective cohort study

Objectives

Socioeconomic disparities and malnutrition are significant contributors to global health challenges, yet the relationship between socioeconomic status (SES) and malnutrition, and the subsequent risk of mortality in cancer patients remains underexplored. This study aimed to investigate the complex relationships between SES, nutritional status, and both all-cause and cancer-specific mortality in cancer patients.

Study design

Prospective cohort study.

Methods

Participants from the UK Biobank with a cancer diagnosis within two years prior to baseline assessment were included (n = 4216, 47.3 % male). Latent class analysis (LCA) and the Global Leadership Initiative on Malnutrition (GLIM) criteria were employed to evaluate patients’ SES and nutritional status. Logistic regression was applied to assess the associations between SES and nutritional status. Cox-proportional hazards models, along with mediation, joint association, and interaction analyses, were done to establish the relationship between SES, nutritional status, and both all-cause and cancer-specific mortality.

Results

During a median follow-up of 15.14 (IQR: 15.09–15.20) years, 1039 participants died, of which 788 deaths were cancer-specific. Participants with low SES (vs high) had an increased risk of malnutrition (OR 1.60, 95 % CI 1.08–2.39) and all-cause mortality (HR 1.22, 95 % CI 1.03–1.44). Malnutrition accounted for 6.8 % of the association between low SES and all-cause mortality. Compared to well-nourished patients with high SES, those with malnutrition and low SES had the highest risk of all-cause mortality (3.12, 2.26–4.29), while those with malnutrition and high SES faced the highest risk of cancer-specific mortality (2.88, 1.97–4.21).

Conclusions

While addressing malnutrition alone may not significantly reduce mortality disparities arising from socioeconomic differences, it remains a crucial strategy for alleviating cancer burden, especially among patients with low SES.