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Meta-Analysis
. 2023 Jan 3;6(1):e2250416.
doi: 10.1001/jamanetworkopen.2022.50416.

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

Randy A Vince Jr  1 , Ralph Jiang  2 , Merrick Bank  3 , Jake Quarles  4 , Milan Patel  5 , Yilun Sun  6 , Holly Hartman  6 , Nicholas G Zaorsky  7 , Angela Jia  7 , Jonathan Shoag  1 , Robert T Dess  8 , Brandon A Mahal  9 , Kristian Stensland  10 , Nicholas W Eyrich  11 , Mariana Seymore  10 , Rebecca Takele  12 , Todd M Morgan  10 , Matthew Schipper  2 , Daniel E Spratt  7
Affiliations
Meta-Analysis

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

Randy A Vince Jr et al. JAMA Netw Open. .

Erratum in

  • Errors in Figure 2.
    [No authors listed] [No authors listed] JAMA Netw Open. 2023 Feb 1;6(2):e231256. doi: 10.1001/jamanetworkopen.2023.1256. JAMA Netw Open. 2023. PMID: 36780169 Free PMC article. No abstract available.

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 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 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Zaorsky reported receiving grants from the National Institutes of Health and the American Cancer Society and receiving remuneration from Springer Nature for his textbook, Absolute Clinical Radiation Oncology Review, and from the American College of Radiation Oncology for chart review and accreditation of radiation oncology facilities nationally. Dr Jia reported receiving personal fees from Myovant outside the submitted work. Dr Shoag reported receiving personal fees from ForTec Medical and grants from Bristol Myers Squibb outside the submitted work. Dr Schipper reported receiving personal fees from Innovative Analytics outside the submitted work. Dr Spratt reported receiving personal fees from AstraZeneca, Blue Earth, Boston Scientific, Bayer, Janssen, Elekta, GammaTile, Novartis, Pfizer/Myovant, and Varian outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Identification and Review of Comparative Effectiveness Research
Figure 2.
Figure 2.. Forest Plot of Prostate Cancer–Specific Mortality (PCSM) and Overall Survival (OS)
HR indicates hazard ratio; SDOH, social determinants of health.
See this image and copyright information in PMC

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