Methods to quantify the attribution of social determinants of health and cancer control measures to cancer mortality

Project Dates: 2023-2024

While cancer affects all population groups, certain underprivileged groups may bear a greater
burden of cancer compared to other groups. For example, the African-American (AA) population has the highest mortality rate of breast, prostate, lung, colorectal, and other major types of cancer, and cancer control policies in recent years have less benefit on the racial and ethnical minority groups. The use of race in healthcare research has been long yet controversial. Various literature has shown that race is a poor proxy for human biological variation but is associated with factors such as social determinants of health (SDOH), which play a key role in racial disparity. The race-based medicine which characterizes race as an essential biological marker and translates it into clinical practice may lead to structural inequality in disease prevention and clinical care. Recently, switching from race-based medicine to race-conscious medicine has drawn much attention and is been increasingly adopted in clinical practice. The race-conscious cancer control requires the analysis of key mediator variables that lie between race and cancer outcomes and explains the underlying mechanism of the observed disparity. Mediators for racial disparity are associated with both race and the outcome. In cancer research, the mediators for racial disparity include SDOH factors (e.g. social-economic, educational, environmental, access to prevention and treatment factors, etc), behavior, and tumor biology. These factors have been extensively studied in literature for cancer disparity. However, the factors are usually analyzed individually for their mediation effects and there are few direct quantifications of their attribution to the racial disparity in cancer outcomes.

Project Goals:

• To quantify the attribution of SDOH factors to the racial disparity in cancer mortality.
• To evaluate the effect of cancer screening on mortality in the Siteman Cancer Center catchment area.

Implications for Research and Practice:

Addressing SDoH in D&I science is one of the most pressing issues for our field. The proposed study will directly inform D&I science in several ways; it will: Provide a more refined and detailed way to populate D&I TMFs, for example, the outer contextual variables in CFIR; Help us in designing and better-targeting implementation strategies in our large and diverse, 82 county catchment area; Allow us to better identify how SDoH factors such as social needs, pollution, healthcare accessibility, and cancer screening behaviors can be integrated in D&I studies;   Develop new D&I measures that more fully integrate SDoH variables in the measures. As a real-time example, in collaboration with Drs. Drake, Liu, and community partners, we will use the output from this project to choose priority components of ongoing scale-up of evidence-based lung screening interventions to evaluate the gain in screening in the county compared to other counties in our Catchment where adjustment is not made for the identified SDoH factors.

Project Contact: Chongliang Lou

Project Team: Bettina Drake, Ying Liu