Race, Social Determinants of Health, and Cancer: How Can APs Address and Improve Patient Outcomes?

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Abstract

The data show that racial and ethnic minority groups throughout the United States experience higher rates of illness and death across a wide range of health conditions when compared to their White counterparts. This session at JADPRO Live Virtual 2021 explained race, social determinants of health, and the impact of health disparities on oncology patients, highlighting concrete ways advanced practitioners can reduce health disparities and improve patient outcomes.

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Cancer health disparities in racial/ethnic minorities in the United States

Valentina A Zavala, Paige Bracci, John Carethers … (2020)

There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA—African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.

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Cancer mortality in the United States by education level and race.

Taylor Murray, Robert Anderson, V Cokkinides … (2007)

Although both race and socioeconomic status are well known to influence mortality patterns in the United States, few studies have examined the simultaneous influence of these factors on cancer incidence and mortality. We examined relationships among race, education level, and mortality from cancers of the lung, breast, prostate, colon and rectum, and all sites combined in contemporary US vital statistics. Age-adjusted cancer death rates (with 95% confidence intervals [CIs]) were calculated for 137,708 deaths among 119,376,196 individuals aged 25-64 years, using race and education information from death certificates and population denominator data from the US Bureau of the Census, for 47 states and Washington, DC, in 2001. Relative risk (RR) estimates were used to compare cancer death rates in persons with 12 or fewer years of education with those in persons with more than 12 years of education. Educational attainment was strongly and inversely associated with mortality from all cancers combined in black and white men and in white women. The all-cancer death rates were nearly identical for black men and white men with 0-8 years of education (224.2 and 223.6 per 100,000, respectively). The estimated relative risk for all-cancer mortality comparing the three lowest ( 12 years) education categories was 2.38 (95% CI = 2.33 to 2.43) for black men, 2.24 (95% CI = 2.23 to 2.26) for white men, 1.43 (95% CI = 1.41 to 1.46) for black women, and 1.76 (95% CI = 1.75 to 1.78) for white women. For both men and women, the magnitude of the relative risks comparing the three lowest educational levels with the three highest within each race for all cancers combined and for lung and colorectal cancers was higher than the magnitude of the relative risks associated with race within each level of education, whereas for breast and prostate cancer the magnitude of the relative risks associated with race was higher than the magnitude of the relative risks associated with level of education within each racial group. Among the most important and novel findings were that black men who completed 12 or fewer years of education had a prostate cancer death rate that was more than double that of black men with more schooling (10.5 versus 4.8 per 100,000 men; RR = 2.17, 95% CI = 1.82 to 2.58) and that, in contrast with studies of mortality rates in earlier time periods, breast cancer mortality rates were higher among women with less education than among women with more education (37.0 and 31.1 per 100,000, respectively, for black women and 25.2 versus 18.6 per 100,000, respectively, for white women). Cancer death rates vary considerably by level of education. Identifying groups at high risk of death from cancer by level of education as well as by race may be useful in targeting interventions and tracking cancer disparities.

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Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy

Kassandra Alcaraz, Tracy L. Wiedt, Elvan C Daniels … (2019)

Although cancer mortality rates declined in the United States in recent decades, some populations experienced little benefit from advances in cancer prevention, early detection, treatment, and survivorship care. In fact, some cancer disparities between populations of low and high socioeconomic status widened during this period. Many potentially preventable cancer deaths continue to occur, and disadvantaged populations bear a disproportionate burden. Reducing the burden of cancer and eliminating cancer-related disparities will require more focused and coordinated action across multiple sectors and in partnership with communities. This article, part of the American Cancer Society's Cancer Control Blueprint series, introduces a framework for understanding and addressing social determinants to advance cancer health equity and presents actionable recommendations for practice, research, and policy. The article aims to accelerate progress toward eliminating disparities in cancer and achieving health equity.

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Author and article information

Journal

Journal ID (nlm-ta): J Adv Pract Oncol

Journal ID (iso-abbrev): J Adv Pract Oncol

Journal ID (publisher-id): J Adv Pract Oncol

Journal ID (publisher-id): JADPRO

Title: Journal of the Advanced Practitioner in Oncology

Publisher: Harborside Press LLC

ISSN (Print): 2150-0878

ISSN (Electronic): 2150-0886

Publication date (Print): April 2022

Publication date (Electronic): 23 May 2022

Volume: 13

Issue: 3

Pages: 221-225

Affiliations

From ¹Sidney Kimmel Cancer Center at Jefferson Health, Philadelphia, Pennsylvania;

²Memorial Sloan Kettering Cancer Center, New York, New York

Article

Publisher ID: 2022.13.3.8

DOI: 10.6004/jadpro.2022.13.3.8

PMC ID: 9126349

PubMed ID: 35663187

SO-VID: 3991d58e-f2e2-419d-8fc9-50f808010805

License:

This article is distributed under the terms of the Creative Commons Attribution Non-Commercial Non-Derivative License, which permits unrestricted non-commercial and non-derivative use, distribution, and reproduction in any medium, provided the original work is properly cited.

Race, Social Determinants of Health, and Cancer: How Can APs Address and Improve Patient Outcomes?

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Cancer Metabolism

Most cited references 15

Cancer health disparities in racial/ethnic minorities in the United States

Cancer mortality in the United States by education level and race.

Understanding and addressing social determinants to advance cancer health equity in the United States: A blueprint for practice, research, and policy

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