SDOH Factors Impact Health Perceptions in Black, Hispanic Ovarian Cancer Survivors

Social determinants of health (SDOH) factors significantly influence the overall health perceptions of Black and Hispanic ovarian cancer survivors, according to a study published in Gynecologic Oncology.¹

Annually, about 20,000 women in the US are diagnosed with ovarian cancer, and 13,000 die from it.² Also, the overall 5-year survival rate for Black women with ovarian cancer is 41% versus 49% for White women. Although ovarian cancer incidence remains higher in White women, the researchers explained that Black and Hispanic women continue to experience disparities in survival and recurrence rates.¹

While the causes of ovarian cancer disparities are multi-dimensional, they considered SDOH to be key contributors. Therefore, the researchers conducted a study to evaluate the influences of SDOH on the perceived health and well-being of Black and Hispanic ovarian cancer survivors compared to White ovarian cancer survivors.

Social determinants of health (SDOH) factors significantly impact the overall health perceptions of Black and Hispanic ovarian cancer survivors. | Image Credit: Seventyfour - stock.adobe.com

Consequently, the researchers conducted a cross-sectional study using overall health and SDOH survey data collected by the National Institutes of Health All of Us Research Program from May 2017 to September 2023.³ The All of Us Research Program collects data from racially and ethnically diverse patients and their electronic health records; currently, more than 500,000 patients are enrolled, 80% from underrepresented populations.⁴

More specifically, they analyzed female Black, White, and Hispanic patients aged 18 or older with malignant ovary tumors who completed the SDOH study survey.¹ Of the 1250 included patients with ovarian cancer, 414 completed SDOH surveys. Of which, 352 (85%) were White, 33 (8%) were Hispanic, and 29 (7%) were Black.

The researchers evaluated the impact of 5 SDOH domains: neighborhood characteristics, supportive relationships, spiritual life, food and housing security, and day-to-day discrimination. They attached a numerical score to patient responses in each category from 0 to 5, the highest score being attributed to the most positive response and vice versa. Therefore, an increase in the SDOH score would indicate incrementally better social conditions for the patient.

Also, the researchers analyzed each patient’s overall health perception by examining the perception of their general health, general mental health, and social satisfaction. To determine each patient's general health perception, the survey asked patients about their health and quality of life. Similarly, the survey evaluated patient’s general mental health perceptions by asking them to rate their mental health, while the social satisfaction perception questions asked patients to rate their satisfaction with social activities and relationships.

As for SDOH factors, the survey included various questions on neighborhood characteristics, like cleanliness, drug use, and crime. For every unit increase in the SDOH neighborhood characteristics score, the odds of having a poor general health perception decreased by 0.96 times.

Also, the supportive relationships survey items asked patients if they had someone to turn to for suggestions or to help them if confined to a bed. For every unit increase in the SDOH score, the odds of having a poor perception of general health and social satisfaction decreased by 0.96 times and 0.94 times, respectively.

Additionally, the spiritual life survey items asked how often patients went to religious meetings or services, as well as how often they felt the power of a higher power. With every unit increase in the SDOH spiritual life score, the odds of having a poor perception of general mental health, social satisfaction, and general health decreased by 0.97, 0.98, and 0.99 times, respectively.

As for food and housing security, the survey asked if patients were worried their food would not last and how often patients moved in the past year. For every unit increase in the SDOH food and housing security score, the odds of having a poor perception of general health and social satisfaction decreased by 0.57 and 0.53 times, respectively.

Lastly, the survey asked patients various questions about day-to-day discrimination, like if they were treated with less respect than others. For every unit increase in the SDOH score, the odds of having a poor perception of social satisfaction, general mental health, and general health decreased by 0.93, 0.94, and 0.95 times, respectively.

Overall, Black ovarian cancer survivors were significantly more likely to have a poor perception of general health, social satisfaction, and general mental health than White ovarian cancer survivors. Similarly, Hispanic ovarian cancer survivors were significantly more likely to have a poor perception of general health, social satisfaction, and general mental health than non-Hispanic ovarian cancer survivors.

The researchers acknowledged their study’s limitations, one being that they did not assess for all possible SDOH factors. This may have accounted for persistent differences between the overall health perceptions of Black and Hispanic ovarian cancer survivors compared to those of White survivors. Despite their limitations, the researchers expressed confidence in their findings, using them to suggest areas for further research.

“While additional SDOH factors should also be explored, our compelling study findings challenge health care professionals and scientists to partner together with communities in designing feasible and imaginative interventions to overcome ovarian cancer care disparities in an equitable manner,” the authors concluded.

References

1. Mahoney DE, Mukherjee R, Thompson J. Elucidating the influences of social determinants of health on perceived overall health among African American/Black and Hispanic ovarian cancer survivors using the NIH All of Us Research Program. Gynecol Oncol. Published online July 9, 2024. doi:10.1016/j.ygyno.2024.06.027
2. Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763
3. All of Us Research Program Investigators, Denny JC, Rutter JL, et al. The "All of Us" Research Program. N Engl J Med. 2019;381(7):668-676. doi:10.1056/NEJMsr1809937
4. Mayo KR, Basford MA, Carroll RJ, et al. The All of Us data and research center: creating a secure, scalable, and sustainable ecosystem for biomedical research. Annu Rev Biomed Data Sci. 2023;6:443-464. doi:10.1146/annurev-biodatasci-122120-104825