社会健康决定因素对癌症结局的不平等具有一定的贡献。州级公共援助支出，包括针对社会经济弱势个体的医疗补助和现金援助计划，可以改善就诊渠道，解决食品和住房安全等障碍，从而改善边缘化人群的癌症结局。为了确定州级公共援助支出是否与癌症患者的总体生存率(OS)有关，以及人种和族裔差异情况下的生存率。本队列研究纳入了2007至2013年间确诊新癌症的年满18岁的美国成年人，并在2019年进行了随访。数据来源于监测、流行病学和终末结果项目。数据分析时间为2021年11月18日至2023年7月6日。差异化的州级公共援助支出。主要结果为6年生存率。分析调整了年龄、种族、族裔、性别、都市居住、县级收入、州固定效应、州级贫困居民和65岁以上居民比例、癌症类型和癌症分期。共鉴定出2,035,977名癌症患者，并纳入分析，其中1,005,702人(49.4%)年满65岁或以上，1,026,309人(50.4%)为男性。根据公共援助支出的三分位数，低位第三分位数的6年生存率为55.9%，中位第三分位数为55.9%，高位第三分位数为56.6%。在经过调整的分析中，州级公共援助支出与更高的6年生存率显著相关(每人均100美元 0.09% [95% CI, 0.04%-0.13%]; P < .001)，特别是对于非西班牙裔黑人个体(每人均100美元 0.29% [95% CI, 0.07%-0.52%]; P = .01)和非西班牙裔白人个体(每人均100美元 0.12% [95% CI, 0.08%-0.16%]; P < .001)而言。在敏感性分析中，考虑到医疗补助支出和医疗补助扩大的额外数据年份，非医疗补助支出与非西班牙裔黑人个体的3年生存率有关(每人均100美元 0.49% [95% CI, 0.26%-0.72%]; 考虑到医疗补助支出的情况下，每人均100美元 0.17% [95% CI, 0.02%-0.31%]，反映医疗补助扩大的影响)。本队列研究发现，州级公共援助支出，包括现金援助计划和医疗补助，与癌症患者的生存率有关。州级公共援助计划的投入可能是改善癌症结局的重要途径，因为它可以解决社会健康决定因素，并应进一步研究。

Social determinants of health contribute to disparities in cancer outcomes. State public assistance spending, including Medicaid and cash assistance programs for socioeconomically disadvantaged individuals, may improve access to care; address barriers, such as food and housing insecurity; and lead to improved cancer outcomes for marginalized populations.To determine whether state-level public assistance spending is associated with overall survival (OS) among individuals with cancer, overall and by race and ethnicity.This cohort study included US adults aged at least 18 years with a new cancer diagnosis from 2007 to 2013, with follow-up through 2019. Data were obtained from the Surveillance, Epidemiology, and End Results program. Data were analyzed from November 18, 2021, to July 6, 2023.Differential state-level public assistance spending.The main outcome was 6-year OS. Analyses were adjusted for age, race, ethnicity, sex, metropolitan residence, county-level income, state fixed effects, state-level percentages of residents living in poverty and aged 65 years or older, cancer type, and cancer stage.A total 2 035 977 individuals with cancer were identified and included in analysis, with 1 005 702 individuals (49.4%) aged 65 years or older and 1 026 309 (50.4%) male. By tertile of public assistance spending, 6-year OS was 55.9% for the lowest tertile, 55.9% for the middle tertile, and 56.6% for the highest tertile. In adjusted analyses, public assistance spending at the state-level was significantly associated with higher 6-year OS (0.09% [95% CI, 0.04%-0.13%] per $100 per capita; P < .001), particularly for non-Hispanic Black individuals (0.29% [95% CI, 0.07%-0.52%] per $100 per capita; P = .01) and non-Hispanic White individuals (0.12% [95% CI, 0.08%-0.16%] per $100 per capita; P < .001). In sensitivity analyses examining the roles of Medicaid spending and Medicaid expansion including additional years of data, non-Medicaid spending was associated with higher 3-year OS among non-Hispanic Black individuals (0.49% [95% CI, 0.26%-0.72%] per $100 per capita when accounting for Medicaid spending; 0.17% [95% CI, 0.02%-0.31%] per $100 per capita Medicaid expansion effects).This cohort study found that state public assistance expenditures, including cash assistance programs and Medicaid, were associated with improved survival for individuals with cancer. State investment in public assistance programs may represent an important avenue to improve cancer outcomes through addressing social determinants of health and should be a topic of further investigation.