Evidence for the Cumulative Impact of Social Determinants of Health (SDOH) on Cancer Mortality: A Scoping Review
Author(s)
Kat M. Aguilar, MPH, PHd(c)1, Robert Reid, MD1, Zhaohui Su, PhD1, Lydia Mills, MSW, LCSW, LICSW2, Jessica K. Paulus, ScD1;
1Ontada, Boston, MA, USA, 2McKesson, The Woodlands, TX, USA
1Ontada, Boston, MA, USA, 2McKesson, The Woodlands, TX, USA
Presentation Documents
OBJECTIVES: Literature on the role of SDOH in cancer outcomes is vast and has increased markedly in the last decade. This scoping review evaluated the breadth of evidence published on the relationship between SDOH and cancer mortality, aiming to distinguish key concepts, common methodologies, and knowledge gaps.
METHODS: Applying Joanna Briggs Institute recommendations, this scoping review evaluated the concept of cancer mortality within the context of SDOH among an adult cancer population within the United States (US). A PubMed search was undertaken on 09/15/2024 using keywords related to SDOH and cancer mortality. Research studies published, in English, after 2019 that reported the influence of composite SDOH metrics on cancer mortality among adult US populations were included.
RESULTS: Across 67 eligible studies, 15 (22%) examined cancer mortality across multiple tumor types, and 38 (57%) included nationwide data. Among 43 included retrospective/prospective studies, race/ethnicity (n=41; 95%) and insurance coverage (n=31; 72%) were most frequently assessed, while education (n=5; 12%), income (n=4; 9%), allostatic load (n=4; 9%), or employment (n=1; 2%) were less common. The 19 cross-sectional/geospatial analyses examined place-based environmental or population characteristics, with rurality most frequently measured (n=13; 68%). Nearly all identified SDOH were associated with cancer mortality in at least one study, though the strength and direction of these correlations were inconsistently reported. Accordingly, 12 approaches for assessing composite socioeconomic status (SES) at the census tract or block group level were identified across 23 studies. Among these studies, nine found a statistically significant association between SES and mortality, six found no association, and eight observed the relationship was influenced by factors such as race/ethnicity.
CONCLUSIONS: This scoping review underscores the complex relationship between cancer mortality and SDOH. The findings suggest that large, nationwide studies of diverse tumor populations using comprehensive individual-level data are needed to improve understanding of how SDOH influence cancer mortality.
METHODS: Applying Joanna Briggs Institute recommendations, this scoping review evaluated the concept of cancer mortality within the context of SDOH among an adult cancer population within the United States (US). A PubMed search was undertaken on 09/15/2024 using keywords related to SDOH and cancer mortality. Research studies published, in English, after 2019 that reported the influence of composite SDOH metrics on cancer mortality among adult US populations were included.
RESULTS: Across 67 eligible studies, 15 (22%) examined cancer mortality across multiple tumor types, and 38 (57%) included nationwide data. Among 43 included retrospective/prospective studies, race/ethnicity (n=41; 95%) and insurance coverage (n=31; 72%) were most frequently assessed, while education (n=5; 12%), income (n=4; 9%), allostatic load (n=4; 9%), or employment (n=1; 2%) were less common. The 19 cross-sectional/geospatial analyses examined place-based environmental or population characteristics, with rurality most frequently measured (n=13; 68%). Nearly all identified SDOH were associated with cancer mortality in at least one study, though the strength and direction of these correlations were inconsistently reported. Accordingly, 12 approaches for assessing composite socioeconomic status (SES) at the census tract or block group level were identified across 23 studies. Among these studies, nine found a statistically significant association between SES and mortality, six found no association, and eight observed the relationship was influenced by factors such as race/ethnicity.
CONCLUSIONS: This scoping review underscores the complex relationship between cancer mortality and SDOH. The findings suggest that large, nationwide studies of diverse tumor populations using comprehensive individual-level data are needed to improve understanding of how SDOH influence cancer mortality.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
SA22
Topic
Study Approaches
Topic Subcategory
Literature Review & Synthesis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Oncology