New University Hospitals Seidman Cancer Center Study Demonstrates the Critical Importance of Social Determinants of Health When Evaluating the Association of Race and Cancer Outcomes

Tuesday, January 17, 2023

Research published in JAMA Network Open of the Journal of American Medical Association

CLEVELAND - A new study led by Randy Vince Jr., MD, MS, and Daniel Spratt, MD, demonstrates the link between cancer outcomes and social determinants of health (SDOH), as opposed to only race.

It is commonly known that Black men have worse prostate cancer outcomes than White men. This association is often described as being driven largely by race in biomedical research, as opposed to other factors such as institutional racism and SDOH.  

Drs. Vince and Spratt recently published in the Journal of Clinical Oncology that less than 5 percent of studies throughout history acknowledge that race is a social construct, nor was there any acknowledgment that this association is potentially driven by racism and SDOH. These findings led to the present study, published by JAMA Network Open on Jan. 11.

This was a meta-analysis of 47 studies of more than 1 million men with prostate cancer. Each individual study investigated the association of race with death from prostate cancer and overall survival between Black and White men. The authors developed a tool to capture the extent that SDOH were accounted for in each study.

In the studies with minimal accounting for SDOH, Black patients had significantly higher mortality than White patients.

However, Black men had significantly lower mortality from prostate disease (called prostate cancer-specific mortality – PCSM) in studies with greater accounting for SDOH. This powerful result highlights the importance of how racial disparities and health outcome research are conducted, as improper methods can lead to improper conclusions that inadvertently perpetuate racialization.

“These findings coincide with the commonly said phrase, ‘racism is the risk factor, not race,’” said Dr. Vince, Assistant Professor of Urology and Director of Minority Men’s Health at University Hospitals, Case Western Reserve University School of Medicine and the lead author of the study. “I hope our results will motivate researchers and society to rethink how we analyze and attempt to address racial disparities. In order to address the current inequities at hand, we must acknowledge the past that has led us to this position. Any efforts to achieve equity that do not recognize and attempt to reverse the impact of various forms of racism will continue to be futile.”

Dr.  Spratt,  senior author and Vincent K. Smith Chair in Radiation Oncology and Professor in the Department of Radiation Oncology at UH Seidman Cancer Center and Case Western Reserve University, said: “The scientific and biomedical fields have inadvertently perpetuated the notion that race, rather than racism, impacts cancer outcomes. This is especially true when it comes to the inferior outcomes for Black patients with cancer. Our study not only demonstrates that most health outcomes research conducted on race and prostate cancer outcomes adjusted for few if any confounding SDOH variables, but when accounting for SDOH even partially, Black men had similar to improved cancer outcomes compared to White men. As race is a social construct, this should not be surprising. However, medical education has been shown to rarely teach, and the biomedical scientific community to rarely report that differences observed between Black and White patients are often driven by SDOH and racism, not race.”
 
Vince RA, Jiang R, Bank M, et al. Evaluation of Social Determinants of Health and Prostate Cancer Outcomes Among Black and White Patients: A Systematic Review and Meta-analysis. The Journal of American Medical Association Network Open. 2023;6(1):e2250416. doi:10.1001/jamanetworkopen.2022.50416

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