Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review

Author:

Jayasekera Jinani1ORCID,El Kefi Safa2,Fernandez Jessica R1,Wojcik Kaitlyn M1,Woo Jennifer M P3ORCID,Ezeani Adaora4ORCID,Ish Jennifer L3ORCID,Bhattacharya Manami5ORCID,Ogunsina Kemi3ORCID,Chang Che-Jung3ORCID,Cohen Camryn M6ORCID,Ponce Stephanie1,Kamil Dalya1,Zhang Julia17,Le Randy1,Ramanathan Amrita L8,Butera Gisela9ORCID,Chapman Christina10ORCID,Grant Shakira J11,Lewis-Thames Marquita W12ORCID,Dash Chiranjeev13ORCID,Bethea Traci N13ORCID,Forde Allana T1ORCID

Affiliation:

1. Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health , Bethesda, MD, USA

2. NYU Langone Health, New York University , New York, NY, USA

3. Epidemiology Branch at the National Institute of Environmental Health Sciences at the National Institutes of Health , Bethesda, MD, USA

4. Health Behaviors Research Branch of the Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute , Rockville, MD, USA

5. Cancer Prevention Fellowship Program, Division of Cancer Prevention, and the Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute , Rockville, MD, USA

6. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health , Rockville, MD, USA

7. Sophomore at Williams College , Williamstown, MA, USA

8. Diabetes, Endocrinology, & Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, MD, USA

9. Office of Research Services, National Institutes of Health Library , Bethesda, MD, USA

10. Department of Radiation Oncology, Baylor College of Medicine, and the Center for Innovations in Quality, Effectiveness, and Safety in the Department of Medicine, Baylor College of Medicine and the Houston Veterans Affairs , Houston, TX, USA

11. Department of Medicine, Division of Hematology, University of North Carolina , Chapel Hill, NC, USA

12. Department of Medical Social Science, Center for Community Health at Northwestern University Feinberg School of Medicine , Chicago, IL, USA

13. Office of Minority Health and Health Disparities Research at the Georgetown-Lombardi Comprehensive Cancer Center , Washington, DC, USA

Abstract

Abstract Purpose Structural racism could contribute to racial and ethnic disparities in cancer mortality via its broad effects on housing, economic opportunities, and health care. However, there has been limited focus on incorporating structural racism into simulation models designed to identify practice and policy strategies to support health equity. We reviewed studies evaluating structural racism and cancer mortality disparities to highlight opportunities, challenges, and future directions to capture this broad concept in simulation modeling research. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review Extension guidelines. Articles published between 2018 and 2023 were searched including terms related to race, ethnicity, cancer-specific and all-cause mortality, and structural racism. We included studies evaluating the effects of structural racism on racial and ethnic disparities in cancer mortality in the United States. Results A total of 8345 articles were identified, and 183 articles were included. Studies used different measures, data sources, and methods. For example, in 20 studies, racial residential segregation, one component of structural racism, was measured by indices of dissimilarity, concentration at the extremes, redlining, or isolation. Data sources included cancer registries, claims, or institutional data linked to area-level metrics from the US census or historical mortgage data. Segregation was associated with worse survival. Nine studies were location specific, and the segregation measures were developed for Black, Hispanic, and White residents. Conclusions A range of measures and data sources are available to capture the effects of structural racism. We provide a set of recommendations for best practices for modelers to consider when incorporating the effects of structural racism into simulation models.

Funder

Division of Intramural Research at the National Institute on Minority Health and Health Disparities of the National Institutes of Health

National Institutes of Health Distinguished Scholars Program

National Cancer Institute

Intramural Research Program at the National Institutes of Health

National Institute of Environmental Health Sciences

Intramural Continuing Umbrella of Research Experiences (iCURE) program at the National Cancer Institute

Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Washington, DC

intramural research program

Division of Cancer Epidemiology and Genetics

Northwestern University Clinical and Translational Sciences Institute grant

National Institutes of Health’s National Institute on Aging

Northwestern University Center for Community Health

National Cancer Institute grant

National Institute on Aging grant

National Institutes of Health under National Cancer Institute Grant

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Oncology

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