Social Determinants Impacting Cancer Health

Social determinants of health highlight disparities in cancer outcomes. The statistics tell a shocking story:

• Black women are 40% more likely to die from breast cancer compared to white women. (1)
• Hispanic people have more than double the mortality rate of liver cancer compared to the white population. (1)
• Compared to patients living in urban communities, liver cancer patients living in rural communities at the time of diagnosis are 12% less likely to receive treatment and have nearly 10% higher mortality. (1)
• Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) individuals have a higher risk of getting cancer than those who identify as heterosexual or cisgender; are less likely to be up to date on cancer screenings, and report higher rates of feeling discriminated against in health care settings. (2)?

How cancer health disparities are measured

The following variables are considered when measuring cancer health disparities:

• Incidence
• Prevalence
• Mortality
• Survival
• Morbidity
• Survivorship
• Financial burden
• Screening rates
• Stage at diagnosis

Factors contributing to cancer health disparities

Multiple factors contribute to cancer health disparities:

• Incidences of cancer are more prevalent among people with a lower education level; face housing insecurity; and/or lack social connections. (3)
• While cancer remains the second leading cause of death in the United States, fewer than 20% of diagnosed adults participate in clinical trials, with the majority of participants (85%) comprised of White middle-aged men. (4)

Much room needed for progress

Certain statistics do demonstrate progress in disparities among cancer outcomes. For example, the disparity in overall cancer mortality rates between Black and Caucasian people has narrowed from 26% in 2000 to 13% in 2019. (5) Yet, the factors contributing to cancer health disparities are complex, with their own set of challenges.

Prevention of health disparities in cancer may be possible

Prevention of health disparities in cancer may fortunately be possible. University of Washington researchers found that nearly half of all cancer deaths are linked with modifiable risk factors, including smoking, drinking alcohol, and being overweight. (6) These very same disparities, however, contribute to these risk factors. For example: (1)

• 27% of American Indian or Alaska Native adults over 18 reported cigarette use in 2020.
• Alcohol consumption is higher among men with lower education and income compared to male college graduates who have higher incomes.
• Among adults, instances of obesity are higher among Black women (57%) compared to White women (40%).

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Why do cancer health disparities exist?

This is a complex question without a simple solution, and we’re asked how we help . Yet, before understanding how organizations can work toward leveling cancer health disparities, it’s important to be clear on the definition. The National Cancer Institute writes, “Adverse differences in cancer measures such as the number of new cases, the number of deaths, cancer–related health complications, survivorship, and quality of life after cancer treatment, screening rates, and stage at diagnosis that exist among certain population groups.”?

The reality is that multiple root causes impact cancer health disparities and must be understood to develop effective strategies for reducing them.

• The impact of socioeconomic status — Socioeconomic status, high-poverty neighborhoods, and low educational levels are all linked to higher death rates from certain types of cancers. If these and other socioeconomic disparities were eliminated, more than one-third of deaths from cancer could be prevented. (1)
• The social imprecision of precision medicine — Precision medicine uses individuals’ personal and cancer profiles — typically based on studies of European individuals, to predict optimal cancer prevention and treatment strategies. Equitably treating cancer requires continued research to deepen our understanding of cancer biology in racial and ethnic minorities and other underserved populations. (1)
• The economics of health disparities — Health disparities limit underserved people’s access to affordable, high-quality healthcare and create avoidable costs and financial waste. Recent studies show that health inequities account for approximately $320 billion in annual health care spending. If unaddressed, this figure could grow to $1 trillion or more by 2040. This projected rise in health care spending could cost the average American at least $3,000 annually, up from today’s cost of $1,000 per year. (7)

How to make reducing cancer health disparities a national priority

Reducing the burden of cancer in racial and ethnic minorities and other underserved populations will require implementing new strategies in public education and evidence-based interventions as part of U.S. public health efforts. (1)

Cancer Moonshot, a national program launched in 2016 and a priority of the Biden administration, is helping make a reduction in cancer health disparities a national priority. A key research goal of Cancer Moonshot is to include people from all backgrounds in clinical trials and make these trials, often burdensome on participants, more accessible. You can read our article about the importance of diversity in clinical trials here.

What AccessHope is doing to help

As we have demonstrated, cancer health disparities comprise many factors, and while AccessHope can’t solve for these, we are working on reducing geographic barriers. AccessHope democratizes access to the latest research from NCI-Designated Comprehensive Cancer Centers in underserved populations by offering leading cancer expertise and support to employees nationwide, regardless of their ZIP code, and without requiring travel.

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References

1 American Association for Cancer Research. AACR Cancer Disparities Progress Report 2022.https://cancerprogressreport.aacr.org/wpcontent/uploads/sites/2/2022/06/AACR_CDPR_2022.pdf . Published 2023. Accessed August 29, 2023.

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2 Stony Brook Medicine. LGBTQ care at Stony Brook Medicine. Stonybrookmedicine.edu Web site. https://www.stonybrookmedicine.edu/LGBTQ/Education/Cancer . Updated 2023. Accessed August 29, 2023.

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3 Medhurst E. Why addressing the social determinants of health is essential in cancer policy. The Health Policy Partnership blog. https://www.healthpolicypartnership.com/why-addressing-the-social-determinants-of-health-is-essential-in-cancer-policy/ . Published February 3, 2023. Accessed August 29, 2023.

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4 Mutale F. Inclusion of racial and ethnic minorities in cancer clinical trials: 30 years after the NIH Revitalization Act, where are we? J Adv Pract Oncol. 13(8): 755–757.

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5 AACR releases cancer disparities progress report [news release]. Philadelphia, PA: American Association for Cancer Research; June 8, 2022. https://www.aacr.org/about-the-aacr/newsroom/news-releases/aacr-releases-cancer-disparities-progress-report/#:~:text=Progress%20Against%20Cancer%20Disparities,Improving%20access%20improves%20outcomes . Accessed August 30, 2023

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6 Reed A. Smoking and other risk factors cause almost half of cancer deaths, study finds. The Guardian. August 18, 2022. https://www.theguardian.com/society/2022/aug/18/cancer-death-risk-factors-smoking-alcohol-global-study . Accessed September 1, 2023.

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7 Bhatt J, Gerhardt, W, Davis, A, et al. US health care can’t afford health inequities. Deloitte? June 22, 2022. https://www2.deloitte.com/us/en/insights/industry/health-care/economic-cost-of-health-disparities.html . Accessed August 30, 2023.

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Originally published: April 1, 2021

Updated: January 9, 2024