Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients

Abstract

ImportanceAs 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.ObjectiveTo evaluate the association of SDOH with prostate cancer–specific mortality (PCSM) and overall survival (OS) among Black and White patients with prostate cancer.Data SourcesA MEDLINE search was performed of prostate cancer comparative effectiveness research from January 1, 1960, to June 5, 2020.Study SelectionTwo 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 SynthesisThree 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 MeasuresThe 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).ResultsThe 47 studies identified comprised 1 019 908 patients (176 028 Black men and 843 880 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 RelevanceThe 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.

The Effect of Racial Concordance on Patient Trust in Online Videos About Prostate Cancer

“…A sample size of 1200 Black adults (or White adults) gives 92% power to detect a 10% difference in trust according to presenter race, qualifications, or video topic. Logistic regression was used for multivariable analysis to examine (1) video features associated with trust with mutual adjustment (speaker race, qualifications, or topic) and (2) individual factors associated with trust across all prostate cancer videos (ie, demographics, health literacy using a validated 3-item scale, 17 eHealth literacy using eHEALS, 18 and medical mistrust 19 as well as video features). Statistical significance was considered as P < .05.…”

“…1 A recent metaanalysis suggested a significant interaction between race and social determinants of health with respect to prostate cancer-specific mortality. 2 In addition, Black men are significantly underrepresented in prostate cancer clinical trials. 3 Black adults have significantly more medical mistrust than their White counterparts.…”

“…Black men are significantly more likely to receive a prostate cancer diagnosis, have worse quality of life, and are more likely to die from prostate cancer compared with non-Hispanic White men . A recent meta-analysis suggested a significant interaction between race and social determinants of health with respect to prostate cancer-specific mortality . In addition, Black men are significantly underrepresented in prostate cancer clinical trials …”

The quality of life value in uro-oncological patients

“…The previously mentioned QoL aspects must be integrated with patients' environmental reality, which portraits the social determinants of health complex. These factors are officially recognized as the nonmedical factors influencing the health outcome: the conditions in which people are born, live, work, grow, and all the daily life influences, synergistically act with economic and social policies, political systems and norms, infrastructure governance and welfare [11,12].…”

Errors in Figure 2

“…In the Original Investigation titled “Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis,” published January 11, 2023, the labels in the forest plot in Figure 2 should be switched in both panels: “Black men at lower risk” should be on the left of the vertical dotted line indicating a hazard ratio of 1.0, and “Black men at higher risk” should be on the right. This article has been corrected …”