Social factors linked to disparities in prostate cancer outcomes among Black vs. white men
A relationship between race and social determinants of health contributed to significantly higher prostate cancer-specific morality among Black men in the United States, results of a meta-analysis in JAMA Network Open showed.
Disparities between Black and white men in prostate-cancer-specific mortality (PCSM) and OS narrowed as studies considered the known impact of social determinants of health on race, the investigators noted.
Background
Previous studies of Black men in the U.S. with prostate cancer showed consistent disparities in social determinants of health that have been associated with poorer health care outcomes, according to Randy A. Vince Jr., MD, MS, of University Hospitals Urology Institute and UH Seidman Cancer Center in Cleveland, and colleagues.
"Prostate cancer is not only the most commonly diagnosed cancer among men, but it also carries with it one of the largest racial disparities in outcomes in oncology,” they wrote. “There has been a substantial research investment to identify biological causes for these racial disparities, yet data to support specific biological factors associated with these racial differences remain limited.”
Methodology
Vince and colleagues conducted a systematic review and meta-analysis to determine whether associations exist between social determinants of health and PCSM and OS among Black and white men with prostate cancer in the United States.
Researchers searched MEDLINE and identified 251 relevant prostate cancer comparative effectiveness studies conducted between Jan. 1, 1960, and June 5, 2020. After extracting data from comparative analysis between Black and white patients from 47 qualifying studies, the researchers performed meta-analyses using both fixed-effects and random-effects models.
The investigators developed a scoring system to quantify how well a study accounted for social determinants of health that included measures of economic stability; health care access and quality; education access and quality; neighborhood and built environment; and social and community context. They divided the scoring system into three categories: high (10 points or more), intermediate (5-9 points), and low (5 points or less).
The study population comprised 1,019,908 men (median age, 66.4 years; interquartile range [IQR], 64.8-69), including 843,880 white men and 176,028 Black men.
Median follow-up was 66 months (IQR, 41.5-91.4).
Key findings
A pooled estimates analysis showed no statistically significant differences in PCSM (HR = 1.08; 95% CI, 0.99-1.19) or OS (HR = 1.01; 95% CI, 0.95-1.07) when comparing Black vs. white patients.
However, the investigators observed significant interactions between race and social determinants of health for both PCSM (regression coefficient = –0.041; 95% CI, –0.059 to 0.023) and OS (meta-regression coefficient = –0.017; 95% CI, –0.033 to –0.002).
Studies with low accounting of social determinants of health showed significantly higher PCSM for Black patients vs. white patients (HR = 1.29; 95% CI, 1.17-1.41). Conversely, studies with the high accounting for social determinants of health showed significantly lower PCSM for Black patients compared with white patients (HR = 0.86; 95% CI, 0.77-0.96).
Clinical implications
The results suggested a significant association between racial disparities in health care and the interaction between race and social determinants of health among men with prostate cancer in the United States, Vince and colleagues noted.
“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,” they wrote. “Ultimately, our results reveal the interplay of societal inequities and prostate cancer outcomes, revealing several potential areas for intervention, starting with how we incorporate variables associated with [social determinants of health] into research.”
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