Impact of individual- and area-level race/ethnicity on illness intrusiveness among cancer survivors.

Many cancer survivors experience illness intrusion or disruption in various life domains from cancer. The socioecological model posits that individual health status is produced by the interaction of individual biology and their surrounding physical, social, and cultural environment. Despite evidence of the need to consider such hierarchical influences, little is known about the impact of area-level factors on cancer-related outcomes, including illness intrusiveness. Data from 993 breast, colorectal, and prostate cancer survivors within the first year of completing treatment were analyzed. Individual-level data for the Illness Intrusiveness Ratings Scale were linked to census tract-level data to characterize neighborhood conditions. Logistic regression modeled the association between individual-level variables, neighborhood-level racial composition, and the interaction between individual and area-level race on illness intrusiveness. A significant number of survivors (232, 23.4%) reported relatively high illness intrusiveness (score >28). The model including the interaction between area- and individual-level race exhibited significantly improved model fit (p < .05). The final model showed that racial minorities living in areas with a higher percentage of racial minorities had higher odds of greater illness intrusion when compared to Whites living in areas with a low percentage of racial minorities (adjusted odds ratio: 1.65, confidence interval: 1.01, 2.68). Results suggest that area-level factors can have profound effects on survivors' processing of their past cancer experience. Findings may support the collective resources model which posits that the effect of area deprivation is greater in certain sociodemographic groups who may find it difficult to seek resources outside of their living area. © Society of Behavioral Medicine 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.