Longitudinal changes in marital status, residence, and income among over 450,000 cancer patients: A SEER-based analysis

Background : The impact of cancer extends beyond clinical outcomes, often disrupting interpersonal relationships, residential stability, and financial security. However, longitudinal evidence on such changes and associated disparities remains limited. Methods : A total of 457,058 adults diagnosed with multiple primary cancers in SEER-17 (2000-2021) were analyzed and changes in marital status, urbanicity, and household income between the first and last recorded diagnoses were assessed. Analyses were stratified by follow-up interval (short: 2-5 and long: >5 years). Logistic regression models adjusted for multiple demographic and clinical factors were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for these changes. Results : Among patients who were married at first diagnosis (n=255,939), 5% became not married (divorced/separated/single) and 11% were widowed; percentages were higher in women (6% not married; 16% widowed) than men (4%; 7%). Non-Hispanic Black (NHB) women and Hispanic women had the highest proportions becoming not married in both short- (8-11%) and long- (11-13%) intervals. Among patients who remained married from first to last diagnosis (n=214,956), 5% changed urbanicity (1.5% more rural; 3.4% more urban) and 26% changed income (15% increase; 10% decrease). In multivariate models, NHB patients had >2-fold higher odds of being unmarried (not married or widowed, adjusted OR=2.47, 95% CI 2.24-2.74 for short- and 2.19, 2.05-2.34 for long-intervals) and higher odds of income decrease (OR=1.22, 1.10-1.36 for short- and 1.44, 1.36-1.53 for long- interval) compared to non-Hispanic White patients. Hispanic patients also had elevated odds of becoming unmarried (OR=1.73,1.56-1.92 for short- and 1.56, 1.46-1.67 for long- interval), while Non-Hispanic Asian/Pacific Islander patients had lower odds of income decrease (OR=0.68, 0.59-0.78 for short- and 0.52, 0.48-0.57 for long- interval). Conclusions : Cancer diagnoses are associated with considerable social-economic disturbances for patients, especially impacting women and vulnerable racial/ethnic populations. These findings emphasize the importance of implementing equity-focused interventions in susceptible demographics to address relationship strain, housing stability, and financial hardship.