title: Relationships between social isolation, neighborhood poverty, and cancer mortality in a population-based study of US adults.
abstract: BACKGROUND
  Social isolation is an important determinant of all-cause mortality, with evidence suggesting an association with cancer-specific mortality as well. In this study, we examined the associations between social isolation and neighborhood poverty (independently and jointly) on cancer mortality in a population-based sample of US adults.
  
  
  METHODS
  Using data from the Third National Health and Nutrition Examination Survey (NHANES III; 1988-1994), NHANES III Linked Mortality File (through 2011) and 1990 Census, we estimated the relationship between social isolation and high neighborhood poverty and time-to-cancer death using multivariable-adjusted Cox proportional hazards models. We examined the associations of each factor independently and explored the multiplicative and additive interaction effects on cancer mortality risk and also analyzed these associations by sex.
  
  
  RESULTS
  Among 16 044 US adults with 17-23 years of follow-up, there were 1133 cancer deaths. Social isolation (HR 1.25, 95% CI: 1.01-1.54) and high neighborhood poverty (HR 1.31, 95% CI: 1.08-1.60) were associated with increased risk of cancer mortality adjusting for age, sex, and race/ethnicity; in sex-specific estimates this increase in risk was evident among females only (HR 1.39, 95% CI: 1.04-1.86). These associations were attenuated upon further adjustment for socioeconomic status. There was no evidence of joint effects of social isolation and high neighborhood poverty on cancer mortality overall or in the sex-stratified models.
  
  
  CONCLUSIONS
  These findings suggest that social isolation and higher neighborhood poverty are independently associated with increased risk of cancer mortality, although there is no evidence to support our a priori hypothesis of a joint effect.
authors.affiliation: Department of Nutritional Sciences, Rutgers School of Health Professions, Newark, NJ, United States of America.|Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States of America.
authors.forename: Andrea
authors.identifier: http://orcid.org/0000-0001-6557-3748
authors.initials: A
authors.lastname: Fleisch Marcus
authors.affiliation: Department of Nutritional Sciences, Rutgers School of Health Professions, Newark, NJ, United States of America.
authors.forename: Alex H
authors.initials: AH
authors.lastname: Illescas
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States of America.|Rutgers School of Criminal Justice, Newark, NJ, United States of America.
authors.forename: Bernadette C
authors.initials: BC
authors.lastname: Hohl
authors.affiliation: Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, United States of America.|Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States of America.
authors.forename: Adana A M
authors.initials: AA
authors.lastname: Llanos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D009749:Nutrition Surveys; D011159:Population Surveillance; D011203:Poverty; D016016:Proportional Hazards Models; D012111:Residence Characteristics; D012934:Social Isolation; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult