Impact of health-related social needs on mortality risk in cancer survivors: evidence from 1999–2018 NHANES

Cancer survivors experience disproportionate burdens of health-related social needs (HRSNs), yet the mortality implications of cumulative HRSN burden remain poorly characterized.
We analyzed 3643 adult cancer survivors from the 1999–2018 National Health and Nutrition Examination Survey. HRSNs burden was assessed based on eight indicators. Cox proportional hazard models were applied to estimate the associations between cumulative number of unmet HRSNs and all-cause, cardiovascular disease (CVD), and cancer mortality, reporting hazard ratios (HRs) and 95% confidence intervals (CIs).
Over a median 85-month follow-up, 1304 (24.99%) participants died, including 433 from cancer and 334 from CVD. Compared to those with 0–1 unmet HRSN, HRs (95% CIs) for participants with 6–8 unmet HRSNs were 4.01 (2.89–5.58) for all-cause mortality, 2.34 (1.08–5.06) for CVD mortality, and 4.00 (2.41–6.64) for cancer mortality. Restricted cubic spline curves found no evidence of non-linear relationships between unmet HRSNs count and all-cause, CVD, and cancer mortality. Associations between HRSN burden and all-cause and cancer mortality were more pronounced in participants under 60 years of age.
Cumulative HRSN burden is associated with mortality risk among cancer survivors, particularly younger adults. Routine HRSNs assessment should be integrated into survivorship care to identify high-risk patients.