Disparities in survival of hematologic malignancies in the context of social determinants of health: a systematic review.

Autor:	Miranda-Galvis M; Georgia Cancer Center, Augusta University, Augusta, GA., Tjioe KC; Georgia Cancer Center, Augusta University, Augusta, GA., Balas EA; Institute of Public and Preventive Health, Augusta University, Augusta, GA., Agrawal G; School of Computing, University of Georgia, Athens, GA., Cortes JE; Georgia Cancer Center, Augusta University, Augusta, GA.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2023 Nov 14; Vol. 7 (21), pp. 6466-6491.
DOI:	10.1182/bloodadvances.2023010690
Abstrakt:	Social determinants of health (SDHs) have been reported as relevant factors responsible for health inequity. We sought to assess clinical data from observational studies conducted in the United States evaluating the impact of SDHs on the outcomes of patients with hematologic malignancies. Thus, we performed a systematic review in 6 databases on 1 September 2021, in which paired reviewers independently screened studies and included data from 41 studies. We assessed the risk of bias using the Joanna Briggs Institute appraisal tools and analyzed the data using a descriptive synthesis. The most common SDH domains explored were health care access and quality (54.3%) and economic stability (25.6%); others investigated were education (19%) and social and community context (7.8%). We identified strong evidence of 5 variables significantly affecting survival: lack of health insurance coverage or having Medicare or Medicaid insurance, receiving cancer treatment at a nonacademic facility, low household income, low education level, and being unmarried. In contrast, the reports on the effect of distance traveled to the treatment center are contradictory. Other SDHs examined were facility volume, provider expertise, poverty, and employment rates. We identified a lack of data in the literature in terms of transportation, debt, higher education, diet, social integration, environmental factors, or stress. Our results underscore the complex nature of social, financial, and health care barriers as intercorrelated variables. Therefore, the management of hematologic malignancies needs concerted efforts to incorporate SDHs into clinical care, research, and public health policies, identifying and addressing the barriers at a patient-based level to enhance outcome equity (PROSPERO CRD42022346854). (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
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