A meta-analysis supported that Black men have similar or better prostate cancer outcomes compared with White men when health care access is equal and treatment is standardized for all patients.
Among men with prostate cancer, race and social determinants of health (SDOH) may interact to influence prostate cancer–specific mortality (PCSM) and overall survival (OS), according to a systematic review and meta-analysis published in JAMA Network Open.
It also supported ideas found in prior research that Black men have similar or better prostate cancer outcomes compared with White men when health care access is made equal and treatment is standardized for all patients. The study authors added that incorporating SDOH variables into data collection and analyses is crucial to developing strategies to achieve health equity for this group.
“The present study, to our knowledge, represents the first comprehensive meta-analysis of studies comparing survival outcomes between Black and White patients with prostate cancer that have been reported in the literature over the past 60 years,” they said.
To come to this finding, the authors conducted a MEDLINE search of US studies on prostate cancer comparative effectiveness published between January 1, 1960, and June 5, 2020. All studies were required to report time-to-event outcomes to be included in the review.
Using data from these studies, 2 authors conducted a comparative outcome analysis between Black and White patients. With the HHS Healthy People 2030 initiative, an SDOH scoring system was used to evaluate the association of SDOH with predefined end points and had 3 categories: high (≥10 points), intermediate (5-9 points), and low (<5 points) accounting for SDOH.
Covariables in the scoring system included age, comorbidities, insurance status, income status, extent of disease, geography, standardized treatment, and equitable and harmonized insurance benefits.
A total of 47 studies with 1,019,908 patients were included in the final review, with 176,028 Black men and 843,880 White men. The median (IQR) age was 66.4 (64.8-69) years and median follow-up was 66 (41.5-91.4) months.
Pooled estimates demonstrated no statistically significant difference in PCSM between Black and White patients (HR, 1.08; 95% CI, 0.99-1.19; P = .08), and results were similar for OS (HR, 1.01; 95% CI, 0.95-1.07; P = .68).
However, the authors did find a significant interaction between race and SDOH 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).
Because of these findings, they also emphasized the need for the biomedical community to transition from race-based research to race-conscious research.
“Although hundreds of studies have demonstrated worse health outcomes for Black patients than other races, race is a social construct and not a causal variable or a surrogate for innate biology,” the authors said. “Thus, while Black race may be associated with worse health outcomes on a population level, Black patients also are affected by structural racism and disparities in SDOH, regardless of their income class or educational level.”
Each study’s SDOH accounting score also played a role in the association between SDOH and PCSM.
Studies with low accounting for SDOH showed Black men had significantly higher PCSM compared with White men (HR, 1.29; 95% CI, 1.17-1.41; P < .001), while studies with high accounting showed Black men had significantly lower PCSM compared with White men (HR, 0.86; 95% CI, 0.77-0.96; P = .02).
Data from some studies included in the meta-analysis highlighted how poverty, which is a key component of SDOH, can be associated with patient outcomes regardless of race. According to the review authors, this is consistent with their findings that disparities in survival outcomes for men with prostate cancer are eliminated when even partially accounting for SDOH.
The authors noted heterogenous reporting quality, inclusion criteria, missing data, and follow-up, as well as lack of individual patient data, as limitations to this review. However, they also said this reflects the quality of data used over the past 60 years on PCSM and OS between Black and White men with prostate cancer.
“These results underscore the importance of accounting for SDOH in racial disparity research,” the authors wrote. “Addressing inequities in SDOH represents modifiable social factors that require attention to reduce the long-standing disparity in prostate cancer health outcomes.”
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. JAMA Netw Open. 2023;6(1):e2250416. doi:10.1001/jamanetworkopen.2022.50416