Comparative analysis of racial disparities in social determinants of health among patients with GI cancer in the All of Us dataset.
Authors: Al Rubaye Manar Z , Zafar Syed Nabeel , LoConte Noelle K. , Owusu-Brackett Nicci , Venkatesh Manasa , Stalter Lily N , Ali Muhammad Maisam , Issaka Sheriff M 
Published: January 2025

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Background:
Social Determinants of Health (SDoH) are key factors in understanding disparities in cancer treatment and outcomes. Examining SDoH across racial and ethnic groups helps uncover the mechanisms behind disparities and identify solutions. This study compared SDoH factors between White (non-Hispanic) and Non-White (Asian, African American, Hispanic) patients diagnosed with Gastrointestinal (GI) cancers using a national dataset.
Methods:
We analyzed data from the All of Us Research Program. Adult patients with GI cancers, identified via ICD-10 and SNOMED codes, who had completed the SoDH surveys were included. Comparative analyses were performed between White and Non-White participants across SDoH constructs, including social/community construct, neighborhood environment, economic stability, and healthcare access using Chi-squared, T-test, and Mann-Whitney U tests as appropriate.
Results:
Of the 6,620 GI cancer patients identified, 1,831 completed the SDoH survey, of which 13.9% were Non-White. The most common cancers were colon and liver, with pancreatic, stomach, rectal, esophageal, and biliary tract cancers also included. White participants were older than Non-White participants (71.0 vs. 64.2 years, SD = 10.7 and 11.4) and reported higher levels of social cohesion (Mean (SD) = 3.92 (0.70) vs. 3.64 (0.76), p < 0.001) and social support (Mean (SD) = 3.92 (1.00) vs. 3.68 (1.11), p < 0.001). Non-White participants experienced greater perceived discrimination (Mean (SD) = 1.73 (0.80) vs. 1.54 (0.57), p = 0.016) and reported more neighborhood physical disorder (p < 0.001). Food insecurity (23.6% vs. 5.8%, p < 0.001) and housing quality issues (41.8% vs. 21.8%, p < 0.001) were more common among Non-White participants, who also faced more delayed medical care (45.9% vs. 32.5%, p < 0.001).
Conclusions:
This study highlights racial disparities in SDoH among GI cancer patients. Non-White participants experienced greater economic instability and neighborhood disorder compared to White participants. The All of Us dataset offers valuable data for examining SDoH in this population, though it may not fully represent the broader US population. As the dataset expands, it will provide more opportunities for comparative analyses among cancer patients across racial and demographic groups.

Construct
White Non-Hispanic (n = 1489)
Non-White (n = 255)
P-Value

Gender: Female, n (%)
827 (55.5)
167 (65.5)
p = 0.010

Social Disorder; mean (SD)
2.10 (0.22)
2.17 (0.28)
p = 0.002

Perceived Stress; mean (SD)
11.36 (7.12)
12.85 (7.99)
p = 0.003

Global Physical Health T-score (SD)
37.16 (1.89)
36.26 (2.08)
p < 0.001

Global Mental Health T-score (SD)
38.30 (1.76)
38.22 (1.86)
p = 0.520

Food Insecurity; n (%)
170 (5.8)
117 (23.6)
p < 0.001

Poor Housing Quality; n (%)
326 (21.8)
127 (41.8)
p < 0.001

Delayed Medical Care; n (%)
484 (32.5)
117 (45.9)
p < 0.001

Cannot afford specialist; n (%)
47 (4.2)
20 (11.9)
p < 0.001