Similar Factors Contribute to Racial Disparities in Cancer, COVID-19

Racial disparities in cancer and COVID-19 outcomes stem from very similar factors, a finding that has significant implications for the public health sector, according to a study published in Clinical Cancer Research.

Racial disparities in cancer outcomes have been well-documented. Researchers noted that within most cancer types, blacks have a lower five-year survival rate than whites. With COVID-19, about 20 percent of cases in the US have occurred in people who are black, even though that population represents only 13 percent of the population. Additionally, while Latinos make up only 17 percent of the population, these individuals account for 32 percent of COVID-19 cases.

Although cancer and COVID-19 seem like very different diseases at first glance, problems like socioeconomic disadvantages, education, lifestyle factors, comorbidities, and limited access to care increase patients’ risk for both cancer and COVID-19. These factors also contribute to worse outcomes with these conditions.

“The similarities between COVID-19 issues and cancer disparities are uncanny,” said John M. Carethers, MD, John G. Searle Professor and Chair of Internal Medicine at Michigan Medicine. 

“In cancer we are seeing in slow motion what has been observed rapidly with COVID – that the same conditions in our society put specific groups at risk for both. If we can fundamentally change socioeconomic inequality, we theoretically could reduce disparities in both diseases.”

The researchers pointed out that risk factors for outcome disparities in both diseases intersect with regard to comorbidities and socioeconomic disadvantage.

“The history of African Americans is characterized by a plethora of human rights violations dating back to the slavery era but persisting today through the effects of implicit biases and systemically compromised educational, professional, and residential opportunities,” the group said.

“In addition to the irrefutable association between impaired access to medical care and the two-fold higher rates of poverty among African Americans compared with White Americans, the cumulative result of this history has been a pervasive negative impact on the overall health of African Americans.”

The team also stated that current research regarding race-stratified outcomes in patients with both COVID-19 infection and cancer is limited.

“Recent studies have implicated germline genetics and epigenetics in the etiology of cancer disparities; inflammatory pathways linked to these genetic patterns might also play a role in the cytokine storm linked to COVID-19 severity,” researchers said.

“Research regarding the interplay of germline genetics and ancestry with cancer, comorbidities, and infectious disease is clearly warranted.”

Researchers recommended several strategies that can be implemented at the federal and local government levels, the hospital and community levels, and the provider and research levels to address COVID-19 disparities and alleviate downstream cancer disparities caused by the pandemic.

“Important ‘lessons learned’ in cancer research include the facts that inadequate diversity in contemporary clinical trial accruals is largely secondary to provider-level impediments with failure to offer participation opportunities to African Americans and comorbidity exclusion criteria that disproportionate affect African Americans; these problems will need to be addressed in COVID-19 research,” researchers stated.

“Efforts to improve diversity in the accrual of patients to cancer and COVID-19 research are necessary so that results can be generalized with confidence, and these efforts deserve to be supported through creative investments by academia, industry, and federal funding sources into safety-net institutions.”

Eliminating disparities in cancer and COVID-19 should be a public health imperative, the team stated.

“These strategies are feasible, but will take political will, and in some cases, funding. It relies on what people are willing to do to make it work,” Carethers concluded. “We have much to do at all levels.”