Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis
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. To evaluate the association of SDOH with prostate cancer-specific mortality (PCSM)...
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| creator | Vince, Jr, Randy A Jiang, Ralph Bank, Merrick Quarles, Jake Patel, Milan Sun, Yilun Hartman, Holly Zaorsky, Nicholas G Jia, Angela Shoag, Jonathan Dess, Robert T Mahal, Brandon A Stensland, Kristian Eyrich, Nicholas W Seymore, Mariana Takele, Rebecca Morgan, Todd M Schipper, Matthew Spratt, Daniel E |
| description | 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.
To evaluate the association of SDOH with prostate cancer-specific mortality (PCSM) and overall survival (OS) among Black and White patients with prostate cancer.
A MEDLINE search was performed of prostate cancer comparative effectiveness research from January 1, 1960, to June 5, 2020.
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.
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.
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 ( |
| doi_str_mv | 10.1001/jamanetworkopen.2022.50416 |
| format | Article |
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To evaluate the association of SDOH with prostate cancer-specific mortality (PCSM) and overall survival (OS) among Black and White patients with prostate cancer.
A MEDLINE search was performed of prostate cancer comparative effectiveness research from January 1, 1960, to June 5, 2020.
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.
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.
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).
The 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).
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.</description><identifier>ISSN: 2574-3805</identifier><identifier>EISSN: 2574-3805</identifier><identifier>DOI: 10.1001/jamanetworkopen.2022.50416</identifier><identifier>PMID: 36630135</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Aged ; Black or African American ; Humans ; Male ; Meta-analysis ; Online Only ; Original Investigation ; Prostate ; Prostate cancer ; Prostatic Neoplasms - epidemiology ; Prostatic Neoplasms - therapy ; Social Determinants of Health ; United States - epidemiology ; Urology ; White</subject><ispartof>JAMA network open, 2023-01, Vol.6 (1), p.e2250416-e2250416</ispartof><rights>2023. This work is published under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright 2023 Vince RA Jr et al. .</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-a364t-fe3d7d04bade448d6d878833607d97ee2004e52092f8039d96ae3a8d5ba798b33</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,860,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36630135$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vince, Jr, Randy A</creatorcontrib><creatorcontrib>Jiang, Ralph</creatorcontrib><creatorcontrib>Bank, Merrick</creatorcontrib><creatorcontrib>Quarles, Jake</creatorcontrib><creatorcontrib>Patel, Milan</creatorcontrib><creatorcontrib>Sun, Yilun</creatorcontrib><creatorcontrib>Hartman, Holly</creatorcontrib><creatorcontrib>Zaorsky, Nicholas G</creatorcontrib><creatorcontrib>Jia, Angela</creatorcontrib><creatorcontrib>Shoag, Jonathan</creatorcontrib><creatorcontrib>Dess, Robert T</creatorcontrib><creatorcontrib>Mahal, Brandon A</creatorcontrib><creatorcontrib>Stensland, Kristian</creatorcontrib><creatorcontrib>Eyrich, Nicholas W</creatorcontrib><creatorcontrib>Seymore, Mariana</creatorcontrib><creatorcontrib>Takele, Rebecca</creatorcontrib><creatorcontrib>Morgan, Todd M</creatorcontrib><creatorcontrib>Schipper, Matthew</creatorcontrib><creatorcontrib>Spratt, Daniel E</creatorcontrib><title>Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis</title><title>JAMA network open</title><addtitle>JAMA Netw Open</addtitle><description>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.
To evaluate the association of SDOH with prostate cancer-specific mortality (PCSM) and overall survival (OS) among Black and White patients with prostate cancer.
A MEDLINE search was performed of prostate cancer comparative effectiveness research from January 1, 1960, to June 5, 2020.
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.
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.
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).
The 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).
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.</description><subject>Aged</subject><subject>Black or African American</subject><subject>Humans</subject><subject>Male</subject><subject>Meta-analysis</subject><subject>Online Only</subject><subject>Original Investigation</subject><subject>Prostate</subject><subject>Prostate cancer</subject><subject>Prostatic Neoplasms - epidemiology</subject><subject>Prostatic Neoplasms - therapy</subject><subject>Social Determinants of Health</subject><subject>United States - epidemiology</subject><subject>Urology</subject><subject>White</subject><issn>2574-3805</issn><issn>2574-3805</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkd1u1DAQhSMEolXpKyALbrjJ4vgncXqBtCyFIhW1oiAurdl40vU2iRfb2WpfgmfG2Zaq9Mr2-JujM3Oy7E1BZwWlxfs19DBgvHX-xm1wmDHK2ExSUZTPskMmK5FzReXzR_eD7DiENaWU0YLXpXyZHfCy5OkhD7M_p1voRojWDcS15Mo1FjryCSP63g4wxDCVzxC6uCIwGHLpXYgQkSxgaNCTizE2rsdA5r0brsnHDpqbPfhrZRN1maQxqZyQObnahYh9KjTkO24t3u65bxghhwG6XbDhVfaihS7g8f15lP38fPpjcZafX3z5upif58BLEfMWuakMFUswKIQypVGVUpyXtDJ1hcgoFSgZrVmrKK9NXQJyUEYuoarVkvOj7MOd7mZc9miaZNFDpzfe9uB32oHV__8MdqWv3VbXSlaSF0ng3b2Ad79HDFH3NjTYdSkcNwbNqlIIURS0TujbJ-jajT4NPFEVlbVidHJ0ckc1acHBY_tgpqB6Sl4_SV5Pyet98qn59eNxHlr_5cz_AvEUsRQ</recordid><startdate>20230103</startdate><enddate>20230103</enddate><creator>Vince, Jr, Randy A</creator><creator>Jiang, Ralph</creator><creator>Bank, Merrick</creator><creator>Quarles, Jake</creator><creator>Patel, Milan</creator><creator>Sun, Yilun</creator><creator>Hartman, Holly</creator><creator>Zaorsky, Nicholas G</creator><creator>Jia, Angela</creator><creator>Shoag, Jonathan</creator><creator>Dess, Robert T</creator><creator>Mahal, Brandon A</creator><creator>Stensland, Kristian</creator><creator>Eyrich, Nicholas W</creator><creator>Seymore, Mariana</creator><creator>Takele, Rebecca</creator><creator>Morgan, Todd M</creator><creator>Schipper, Matthew</creator><creator>Spratt, Daniel E</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230103</creationdate><title>Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis</title><author>Vince, Jr, Randy A ; Jiang, Ralph ; Bank, Merrick ; Quarles, Jake ; Patel, Milan ; Sun, Yilun ; Hartman, Holly ; Zaorsky, Nicholas G ; Jia, Angela ; Shoag, Jonathan ; Dess, Robert T ; Mahal, Brandon A ; Stensland, Kristian ; Eyrich, Nicholas W ; Seymore, Mariana ; Takele, Rebecca ; Morgan, Todd M ; Schipper, Matthew ; Spratt, Daniel E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a364t-fe3d7d04bade448d6d878833607d97ee2004e52092f8039d96ae3a8d5ba798b33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Aged</topic><topic>Black or African American</topic><topic>Humans</topic><topic>Male</topic><topic>Meta-analysis</topic><topic>Online Only</topic><topic>Original Investigation</topic><topic>Prostate</topic><topic>Prostate cancer</topic><topic>Prostatic Neoplasms - epidemiology</topic><topic>Prostatic Neoplasms - therapy</topic><topic>Social Determinants of Health</topic><topic>United States - epidemiology</topic><topic>Urology</topic><topic>White</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vince, Jr, Randy A</creatorcontrib><creatorcontrib>Jiang, Ralph</creatorcontrib><creatorcontrib>Bank, Merrick</creatorcontrib><creatorcontrib>Quarles, Jake</creatorcontrib><creatorcontrib>Patel, Milan</creatorcontrib><creatorcontrib>Sun, Yilun</creatorcontrib><creatorcontrib>Hartman, Holly</creatorcontrib><creatorcontrib>Zaorsky, Nicholas G</creatorcontrib><creatorcontrib>Jia, Angela</creatorcontrib><creatorcontrib>Shoag, Jonathan</creatorcontrib><creatorcontrib>Dess, Robert T</creatorcontrib><creatorcontrib>Mahal, Brandon A</creatorcontrib><creatorcontrib>Stensland, Kristian</creatorcontrib><creatorcontrib>Eyrich, Nicholas W</creatorcontrib><creatorcontrib>Seymore, Mariana</creatorcontrib><creatorcontrib>Takele, Rebecca</creatorcontrib><creatorcontrib>Morgan, Todd M</creatorcontrib><creatorcontrib>Schipper, Matthew</creatorcontrib><creatorcontrib>Spratt, Daniel E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA network open</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vince, Jr, Randy A</au><au>Jiang, Ralph</au><au>Bank, Merrick</au><au>Quarles, Jake</au><au>Patel, Milan</au><au>Sun, Yilun</au><au>Hartman, Holly</au><au>Zaorsky, Nicholas G</au><au>Jia, Angela</au><au>Shoag, Jonathan</au><au>Dess, Robert T</au><au>Mahal, Brandon A</au><au>Stensland, Kristian</au><au>Eyrich, Nicholas W</au><au>Seymore, Mariana</au><au>Takele, Rebecca</au><au>Morgan, Todd M</au><au>Schipper, Matthew</au><au>Spratt, Daniel E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis</atitle><jtitle>JAMA network open</jtitle><addtitle>JAMA Netw Open</addtitle><date>2023-01-03</date><risdate>2023</risdate><volume>6</volume><issue>1</issue><spage>e2250416</spage><epage>e2250416</epage><pages>e2250416-e2250416</pages><issn>2574-3805</issn><eissn>2574-3805</eissn><abstract>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.
To evaluate the association of SDOH with prostate cancer-specific mortality (PCSM) and overall survival (OS) among Black and White patients with prostate cancer.
A MEDLINE search was performed of prostate cancer comparative effectiveness research from January 1, 1960, to June 5, 2020.
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.
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.
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).
The 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).
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.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>36630135</pmid><doi>10.1001/jamanetworkopen.2022.50416</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Black or African American Humans Male Meta-analysis Online Only Original Investigation Prostate Prostate cancer Prostatic Neoplasms - epidemiology Prostatic Neoplasms - therapy Social Determinants of Health United States - epidemiology Urology White |
| title | Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis |
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