Social Determinants of Health Analysis Reinterprets Race-Linked Cancer Outcomes
February 14, 2023
Innovations in Urology | Winter 2023
Physician-researchers at University Hospitals Cleveland Medical Center recently released a compelling meta-analysis of prior studies of over 1 million men with prostate cancer. Published in the JAMA Network Open of the Journal of American Medical Association, their findings revealed that insufficient accounting for social determinants of health (SDOH) resulted in Black men appearing to have significantly higher prostate cancer-specific mortality (PCSM) than White men.
Paradoxically, in studies with a more realistic accounting for SDOH, Black men were found to have significantly lower PCSM. These discoveries call into question the long-standing medical bias that Black men are genetically at greater risk for poorer prostate cancer outcomes.
“After reviewing studies dating back to the 1960s, we found that very few authors addressed the impact of racial discrimination or social determinants of health on prostate cancer,” says Randy Vince Jr, MD, MS, a urologic oncologist within the University Hospitals Urology Institute, and Minority Men’s Health Director for University Hospitals Cutler Center for Men.
Along with Daniel Spratt, MD, Vincent K. Smith Chair in Radiation Oncology at UH Seidman Cancer Center and Professor, Case Western Reserve University School of Medicine, Dr. Vince determined that less than 5 percent of the 47 studies included in their historical analysis acknowledged race as a social construct or identified a potential link between SDOH and cancer outcomes. The results of their retrospective appeared in the Journal of Clinical Oncology.
“That review of past studies led us to develop a biometric tool to capture the extent to which stressors that impact lived experience were accounted for,” says Dr. Vince. “As we examined our results, it reinforced the harm racial disparities play in restricting access to optimal treatment.”
A Troubling Conversation
Growing up in Baltimore’s inner city, Dr. Vince did not picture himself becoming a surgeon. “I come from humble beginnings, and I didn’t see many people in my neighborhood go to college,” he says. “After I made up my mind to go to medical school, I remember sitting in lectures hearing that, as a Black man, I was at greater risk for heart disease, cancer, or diabetes. One day, a urologist was lecturing about prostate cancer, and I remember asking if there was research about how Black people have been less likely to receive health care and how that may impact outcomes. He said, ‘Oh, no. It is just Black people’s genetics,’ and it didn’t sit well with me. I have always had this thirst for knowledge. Knowing how we define race in this country, that conversation sparked my interest in exploring the relationship between racial health care disparities and social determinants of health.”
The most prevalent cancer in men, prostate cancer outcomes represent one of the largest racially linked discrepancies in oncology. Yet, significant SDOH gaps have been neglected in research. Black men with prostate cancer are more likely to experience:
- Economic and health insurance instability
- Reduced access to quaternary health care centers
- Lower likelihood of comorbidity treatment
- Reduced rates of prostate-specific antigen screening
- Diminished access to curative-intent treatment
“For too long, patient care has been driven by the faulty presumption that race — and not racism — accounts for perceived risk. If we are going to achieve lasting change, we need to be proactive about collecting and acknowledging the data,” says Dr. Vince. “I hope our findings will motivate leaders in health care and society to develop initiatives that address continuing inequities.”
The U.S. Department of Health and Human Services’ Healthy People 20301 initiative defines SDOH as “the conditions in the environments where people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.” Grouped into five domains, they are:
- Economic stability
- Education access and quality
- Health care access and quality
- Neighborhood and built environment
- Social and community context
“My goal is to use my platform as a surgeon and researcher to bring greater awareness to the interconnectedness of those domains,” says Dr. Vince. “If you live in a high-poverty neighborhood, the schools you attend will probably be underperforming. Your ability to get health care will probably be diminished, and crime will be elevated. It doesn't matter the racial composition of your neighborhood; as the level of disadvantage increases, so do violence and disparities.”
For more information, contact Dr. Vince at Randy.Vince@UHhospitals.org.
1 Healthy People 2030. Social Determinants of Health. U.S. Department of Health and Human Services. https://health.gov/healthypeople/priority-areas/social-determinants-health
Randy Vince, Jr., MD, MS
Urologic Oncologist, University Hospitals Urology Institute
Minority Men’s Health Director, University Hospitals Cutler Center for Men
University Hospitals Cleveland Medical Center
Assistant Professor of Urology
Case Western Reserve University School of Medicine