Social determinants of health are major contributors to excess prostate cancer mortality among Black men in the United States, a new study suggests.
In a meta-analysis of 47 studies, investigators compared prostate cancer-specific mortality and overall survival between 176,028 Black men and 843,880 White men (median age, 66.4 years). In studies with a low accounting for social determinants of health, Black patients had a significant 29% increased prostate cancer-specific mortality risk compared with White patients, Randy A. Vince Jr, MD, MS, of University Hospitals, Case Western Reserve University, in Cleveland, Ohio, and colleagues reported in JAMA Network Open. In studies with a high accounting for social determinants of health, however, Black patients had a significant 14% decreased prostate cancer-specific mortality risk compared with White patients.
The investigators scored studies into high (10 points or more), intermediate (5-9 points), and low (less than 5 points) groups based on their level of adjustment and accounting for social determinants of health variables. These variables included income and neighborhood factors such as insurance status, income status, and geography. They also included age, comorbidities, extent of disease, “equitable and harmonized” insurance benefits providing access to standard-of-care treatment, and receipt of standardized treatment.
Dr Vince’s team explained that Black men with prostate cancer in the United States tend to experience health disparities such as decreased access to health care, reduced PSA screening, economic instability, less than guideline-concordant cancer care, more comorbidities, untreated comorbidities, lower rates of curative-intent treatment, and reduced access to high-volume centers.
In a meta-analysis of 36 of the studies, the investigators also found no significant overall survival differences between Black and White patients. Most of the studies had intermediate (44.4%) or high (41.7%) scores for adjustment of social determinants of health.
“Our results align with prior studies that demonstrate that when access to care is equal and treatment is standardized for all patients, Black men have similar or better prostate cancer outcomes,” Dr Vince’s team wrote.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Vince Jr RA, Jiang R, Bank M, et al. Evaluation of social determinants of health and prostate cancer outcomes among Black and White Patients: A systematic review and meta-analysis. JAMA Netw Open. Published online January 11, 2023. doi:10.1001/jamanetworkopen.2022.50416