Disparities in Survival of Hematologic Malignancies in the Context of Social Determinants of Health: A Systematic Review.

Social Determinants of Health (SDH) have been reported as relevant factors responsible for health inequity. We sought to assess clinical data from observational studies evaluating the impact of SDH on the outcomes of patients with hematologic malignancies. Thus, we performed a systematic review in 6 databases on September 1, 2021, in which paired reviewers independently screened studies and included data from 41 studies. We assessed the risk of bias by the Joanna Briggs Institute appraisal tools and analyzed the data using a descriptive synthesis. The most common SDH domains explored were healthcare 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 five variables significantly affecting survival: lack of health insurance coverage or having Medicare or Medicaid insurance; receiving cancer treatment at a non-academic 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 SDH examined were facility volume, provider expertise, poverty, and employment rates. We identified 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 the social, financial, and healthcare barriers as intercorrelated variables. Therefore, the management of hematologic malignancies needs concerted efforts into incorporating SDH into clinical care, research, and public health policies, identifying and addressing the barriers at a patient-based level to enhance outcome equity (PROSPERO CRD42022346854).