Abstract C068: Socioeconomic factors associated with mental health disparities between Missouri and Midwestern cancer survivors: A 2024 BRFSS analysis

Abstract

Cancer survivorship continues to increase due to advances in early detection and treatment. Despite improvements in survival, psychological distress remains a concern for cancer survivors. Missouri faces unique cancer-related public health challenges compared to other states, including a higher cancer mortality rate, a large rural population and a lower median household income than the national average. Prior studies have shown rural-urban differences in mental health among cancer survivors; however, it remains unclear how Missouri’s mental health burden compares to neighboring Midwestern states, and which specific socioeconomic factors drive this disparity. In this study, we use the 2024 Behavioral Risk Factor Surveillance System (BRFSS) data to compare poor mental health among cancer survivors in Missouri and neighboring Midwestern states and evaluate the contribution of demographic and socioeconomic factors. BRFSS survey data was analyzed for participants reporting a history of melanoma or other non-skin cancer diagnoses (n=53,981). Poor mental health was defined as the number of days within a 30-day period when mental health was self-reported as “not good.” Within our comparison group, 758 responders resided in Missouri and 14,110 resided in neighboring Midwestern States, as defined by the U.S. Census Bureau. Covariates included age, sex, race, household income, and rural vs urban residence. Welch’s two-sample t-tests and multivariable linear regression models were performed with significance defined as p<0.05. Missouri cancer survivors reported more poor mental health days within a 30-day period than survivors in neighboring Midwestern states (4.9 vs 4.11 days, p =0.034). Although Missouri residence was initially associated with 0.79 additional poor mental health days, this difference decreased to 0.31 days after adjusting for age, sex, household income, and rural versus urban residence and was no longer significant (p=0.35). Household income below $15,000 annually was the strongest predictor of poor mental health in cancer survivors residing in Missouri (p<0.001). Rural residence was associated with 0.59 less poor mental health days than those residing in urban communities (p=0.001). The increased mental health burden among Missouri cancer survivors appears driven by household income rather than geographic residence alone. After adjusting for rural vs urban residence, cancer survivors in rural Missouri communities reported fewer poor mental health days. This finding warrants further investigation into factors that may not have been included in our BRFSS survey analysis, such as community support. In summary, our findings suggest the need for incorporating routine financial and mental health screening tools into primary care visits. Integrating oncology validated tools into primary care visits may be helpful for reducing mental health disparities among cancer survivors in Missouri and states across the Midwest. George P. Philipopoulos, Kate Backes. Socioeconomic factors associated with mental health disparities between Missouri and Midwestern cancer survivors: A 2024 BRFSS analysis [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr C068.