A systematic review presented at the 2023 Society of Hematologic Oncology (SOHO) Annual Meeting identified five social determinants of health that are contributing to survival disparities in patients with hematologic malignancies. These determinants include lack of access to health insurance, treatment at non-academic facilities, low income or education level, and unmarried status. The review analyzed survival outcomes in different subgroups of patients with hematologic cancers and found that while overall survival was improving, disparities were widening.
The study found that insurance status and facility type were significantly associated with survival, with insurance status showing a stronger correlation. Distance traveled, provider expertise, and marital status were also found to be significant factors. When examining economic stability and education, income and high school education were significantly associated with survival, while employment and ninth-grade education showed no correlation. Poverty was inconclusive in its impact on survival.
Marisol Miranda-Galvis, the research project manager at Georgia Cancer Center, emphasized the need to address these disparities and identify actions that clinicians can take to help close the gap. Social determinants of health were defined as non-biological factors that influence health outcomes, including education access and quality, healthcare access and quality, social and community context, economic stability, and neighborhood/built environment.
To be included in the review, studies needed to meet certain criteria, such as focusing on hematologic cancer patients, evaluating social determinants of health, and being observational studies conducted in the United States. A total of 24,353 patients were included in the review, with various types of hematologic malignancies represented.
The study evaluated different aspects of health care access, economic stability, education, and social context. Key findings included lower survival rates for patients with Medicaid, Medicare, or no insurance compared to those with private or military coverage. Treatment at academic or research institutions was associated with better mortality outcomes compared to non-academic facilities. Lower income and education levels were also linked to poorer survival outcomes.
The study highlights the need to address social determinants of health in order to reduce survival disparities in patients with hematologic malignancies. By understanding the impact of factors such as health insurance, facility type, income, and education, clinicians can implement interventions to improve outcomes for all patients. Further research is needed to better understand the specific actions that can be taken to address these disparities and improve survival rates.