Social determinants of health associated with different prostate cancer outcomes by race

Race and social determinants of health (SDOH) may interact and influence in men with prostate cancer prostate cancer– Specific mortality (PCSM) and overall survival (OS), according to systematic reviews and meta-analyses JAMA network open.

Previous studies also found that black men had similar or better prostate cancer outcomes compared to white men if access to health care was made equal and treatment for all patients was standardized. The study authors added that incorporating SDOH variables into data collection and analysis is important for developing strategies to achieve health equity in this group.

“To our knowledge, this study is the first comprehensive meta-analysis of studies comparing survival outcomes in black and white patients with prostate cancer reported in the literature over the past 60 years,” they wrote. Stated.

To arrive at this finding, the authors conducted a MEDLINE search of US studies of comparative efficacy in prostate cancer published between January 1, 1960 and June 5, 2020. review.

Using data from these studies, two authors performed a comparative outcome analysis for black and white patients. The HHS Healthy People 2030 initiative uses the SDOH scoring system to assess the association between SDOH and pre-defined endpoints, with a high (≥10 points), moderate (5–9 points), low (5 We have set up three categories for less than a point. ) Description of SDOH.

Covariates in the scoring system included age, comorbidities, insurance status, income status, disease extent, geography, standardized treatment, and equitable and harmonized benefits.

A total of 47 studies involving 1,019,908 patients were included in the final review, including 176,028 black and 843,880 white men. Median age (IQR) was 66.4 (64.8-69) years and median follow-up was 66 (41.5-91.4) months.

Pooled estimates showed no statistically significant difference in PCSM between black and white patients (HR, 1.08; 95% CI, 0.99-1.19; P. = .08), and the results were similar for OS (HR, 1.01; 95% CI, 0.95–1.07; P. = .68).

However, the authors found a significant interaction between race and SDOH in both PCSMs (regression coefficient, -0.041; 95% CI, -0.059 to 0.023; P. < .001) and OS (meta-regression coefficient, -0.017; 95% CI, -0.033 to -0.002; P. = .03).

Because of these findings, they also emphasized the need for the biomedical community to move from race-based research to race-conscious research.

“Hundreds of studies show that black patients are worse off than other races, but race is a social construct, not a causal variable or surrogate of innate biology.” “Thus, while blacks may be associated with worsening health conditions at the population level, black patients, regardless of income class or education level, are more likely to be associated with structural racism and We are also affected by SDOH disparities.”

SDOH accounting scores in each study also played a role in the association between SDOH and PCSM.

A study with less explanation for SDOH showed that black men had significantly higher PCSM compared with white men (HR, 1.29; 95% CI, 1.17-1.41; P. < .001), a high accounting study showed that black men had significantly lower PCSM compared with white men (HR, 0.86; 95% CI, 0.77–0.96; P. = .02).

Data from several studies included in the meta-analysis highlight how poverty, a key component of SDOH, may be associated with patient outcomes, regardless of race. According to the review authors, this is consistent with their findings that disparities in survival outcomes among men with prostate cancer are eliminated even when SDOH is partially considered.

The authors noted quality of reporting, inclusion criteria, missing data, heterogeneity in follow-up, and lack of individual patient data as limitations of this review. However, he says this reflects the quality of data used over the past 60 years regarding her PCSM and her OS among black and white men with prostate cancer.

“These results highlight the importance of SDOH accountability in racial disparity studies,” the authors wrote. It represents a modifiable social factor that needs attention to reduce the imbalance of

reference

Vince RA, Jiang R, Bank M et al. Evaluation of social determinants of health and prostate cancer outcome in black and white patients: a systematic review and meta-analysis. JAMA net opened. 2023;6(1):e2250416.doi:10.1001/jamanetworkopen.2022.50416