Evaluation of Social Determinants of Health and Prostate Cancer Outcomes among Black and White Patients: A Systematic Review and Meta-analysis

• Authors: Randy A Vince, University Hospitals Case Medical Center; Ralph Jiang, University of Michigan, Ann Arbor; Merrick Bank, University of Michigan, Ann Arbor; Jake Quarles, Central Michigan University; Milan Patel, University of Michigan Medical School; Yilun Sun, Case Western Reserve University; Hollly Hartman, Case Western Reserve University; Nicholas G Zaorsky, University Hospitals Case Medical Center; Angela Jia, University Hospitals Case Medical Center; Jonathan Shoag, University Hospitals Case Medical Center; Robert T Dess, University of Michigan, Ann Arbor; Brandon A Mahal, University of Miami; Kristian Stensland, University of Michigan, Ann Arbor; Nicholas W Eyrich, Emory University School of Medicine; Mariana Seymore, University of Michigan, Ann Arbor; Rebecca Takele, Albany Medical College; Todd M Morgan, University of Michigan, Ann Arbor; Matthew Schipper, University of Michigan, Ann Arbor; Daniel E Spratt, University Hospitals Case Medical Center
• Journal Title: JAMA Network Open
• Volume: Volume 6, Number 1
• Publisher: JAMA Network Open. | 2023-01-11, Pages E2250416-E2250416
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1001/jamanetworkopen.2022.50416
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Oncology
• Keywords: Aged; Humans; Male; Prostate; Prostatic Neoplasms; Social Determinants of Health; United States; White; Black or African American

Abstract

Importance: 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. Objective: To evaluate the association of SDOH with prostate cancer-specific mortality (PCSM) and overall survival (OS) among Black and White patients with prostate cancer. Data Sources: A MEDLINE search was performed of prostate cancer comparative effectiveness research from January 1, 1960, to June 5, 2020. Study Selection: Two authors independently selected studies conducted among patients within the United States and performed comparative outcome analysis between Black and White patients. Studies were required to report time-to-event outcomes. A total of 251 studies were identified for review. Data Extraction and Synthesis: Three authors independently screened and extracted data. End point meta-analyses were performed using both fixed-effects and random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed, and 2 authors independently reviewed all steps. All conflicts were resolved by consensus. Main Outcomes and Measures: The primary outcome was PCSM, and the secondary outcome was OS. With the US Department of Health and Human Services Healthy People 2030 initiative, an SDOH scoring system was incorporated to evaluate the association of SDOH with the predefined end points. The covariables included in the scoring system were age, comorbidities, insurance status, income status, extent of disease, geography, standardized treatment, and equitable and harmonized insurance benefits. The scoring system was discretized into 3 categories: high (≥10 points), intermediate (5-9 points), and low (<5 points). Results: The 47 studies identified comprised 1019908 patients (176028 Black men and 843880 White men; median age, 66.4 years [IQR, 64.8-69.0 years]). The median follow-up was 66.0 months (IQR, 41.5-91.4 months). Pooled estimates found no statistically significant difference in PCSM for Black patients compared with White patients (hazard ratio [HR], 1.08 [95% CI, 0.99-1.19]; P =.08); results were similar for OS (HR, 1.01 [95% CI, 0.95-1.07]; P =.68). There was a significant race-SDOH interaction for both PCSM (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). In studies with minimal accounting for SDOH (<5-point score), Black patients had significantly higher PCSM compared with White patients (HR, 1.29; 95% CI, 1.17-1.41; P <.001). In studies with greater accounting for SDOH variables (≥10-point score), PCSM was significantly lower among Black patients compared with White patients (HR, 0.86; 95% CI, 0.77-0.96; P =.02). Conclusions and Relevance: The findings of this meta-analysis suggest that there is a significant interaction between race and SDOH with respect to PCSM and OS among men with prostate cancer. Incorporating SDOH variables into data collection and analyses are vital to developing strategies for achieving equity.