Impact of social determinants of health on cervical cancer stage at presentation among women in Zambia: a cross-sectional single-center epidemiological study

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BACKGROUND: The impact of social determinants of health (SDOH) on cervical cancer stage in Zambia remains poorly understood and understudied. METHODS: In this cross-sectional study, we administered the Accountable Health Communities Health-Related Social Needs Screening Tool, modified for Zambian culture, to newly diagnosed cervical cancer patients at the Cancer Diseases Hospital (CDH) in Lusaka, Zambia, between June 2022 and March 2025. The primary aim of the study was to determine the relationship between sociodemographic factors, SDOH domains, and advanced cervical cancer stage (FIGO stage III/IV) at presentation to CDH. Univariate and multivariate logistic regression models were performed to determine associations. RESULTS: There were 259 survey respondents, with a median age of 50 years (range: 29-78); 47.1% of them were diagnosed with advanced cervical cancer, 55.2% were living with HIV, and most (79.1%) had completed primary (grades 1-7) or secondary (grades 8-12) education. In unadjusted analyses, lack of knowledge about cervical cancer risks and symptoms, rural residence, lower educational attainment, cooking outside the home, and staying in the hospital during treatment were associated with advanced FIGO stage at diagnosis. In contrast, lack of knowledge about cervical cancer risks and symptoms, a measure of health literacy, remained independently associated with advanced cervical cancer stage in the adjusted model (OR = 1.79, 95% CI: 1.03-3.11; p = 0.040). CONCLUSIONS: Although additional studies are needed to understand how SDOH contribute specifically to access to cervical cancer prevention and diagnostic services in low-and middle income countries, we found that lack of awareness about the risks and symptoms of cervical cancer is one SDOH associated with advanced cancer stage at presentation. Our study therefore provides a basis for future development of educational strategies to increase awareness of the importance of screening and early diagnosis and reduce late-stage cervical cancer presentations in these settings.

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