Race a Key SDOH Fueling Health Disparities in Cancer Outcomes

New research out of the University Hospitals Seidman Cancer Center and the University of Michigan adds to evidence that race as a social determinant of health (SDOH) is a crucial contributor to worse prostate cancer outcomes and health disparities for Black men.

Using data extracted through MEDLINE,  the University of Michigan researchers aimed to inform health equity-focused strategies.

“As the field of medicine strives for equity in care, research showing the association of social determinants of health (SDOH) with poorer health care outcomes is needed to better inform quality improvement strategies,” lead researcher Randy Vince JR, MD, assistant professor at University Hospitals Seidman Cancer Center and colleagues, said in the study.

“Incorporating SDOH variables into data collection and analyses are vital to developing strategies for achieving equity,” the researchers continued.

Prostate cancer is the most commonly diagnosed cancer among men, but it holds one of the largest racial disparities in outcomes in oncology.

Black men with prostate cancer in the US face various disparities stemming from SDOH, such as decreased care access, reduced prostate-specific antigen screening, economic instability, lower likelihood of treatment of comorbid conditions, and reduced access to high-volume centers, which can lead to poor health outcomes.

The analysis of one million patients used data from 47 studies to examine the association between race, SDOH, and differences in oncologic outcomes between Black and White men with prostate cancer.

“In this meta-analysis of more than 1 million patients, we found an interaction between race, SDOH, and survival outcomes for men with prostate cancer,” the researchers stated. “When accounting for select established disparities in SDOH, Black men with prostate cancer had similar or improved survival outcomes than White men with prostate cancer.”

The findings showed that studies that poorly accounted for known disparities in SDOH between Black and White men highlighted greater mortality in Black patients.

“Although hundreds of studies have demonstrated worse health outcomes for Black patients than other races, race is a social construct and not a causal variable or a surrogate for innate biology,” the researchers stated. “Thus, while Black race may be associated with worse health outcomes on a population level, Black patients also are affected by structural racism and disparities in SDOH, regardless of their income class or educational level.”

Other evidence found that patients in poor or low-income communities also had higher cancer mortality rates. However, the association of living in poverty is demonstrated in health outcomes regardless of race, despite Black patients being more likely to live in high-poverty areas.

These findings come as healthcare leaders work to better understand the driving forces behind racial health disparities.

Back and Hispanic patients have worse outcomes across nearly all disease states, including all-cause mortality, than White adults, according to a report by the Commonwealth Fund.

These unequal healthcare outcomes are likely to the credit of unequal access to care, something nearly all racial or ethnic minorities face, the report continued.

Other care access barriers can be credited to immigration concerns, gaps in existing health insurance coverage, cost, and geographic barriers.