Beyond survival: Understanding the social dimensions of prostate cancer.

28 Background: Prostate cancer carries one of the highest burdens of racial disparities in outcomes in oncology. Understanding social determinants of health (SDOH), which measure inequities in healthcare, could give us insight into quality improvement strategies. We aimed to study the impact of key SDOH measures (everyday discrimination, supportive relationships, neighborhood characteristics, and food and housing security) on the perception of overall health in prostate cancer survivors using a publicly available database. Methods: A cross-sectional study was conducted using overall health and SDOH survey data collected by the National Institutes of Health All of Us Research Program from June 2017 to June 2022. Ordinal logistic regression was utilized to assess associations between overall perception of health and each specific SDOH survey domain. All statistical tests were two-sided, and a p-value less than 0.05 was statistically significant; multiplicity adjustments were not made. The Statistical package (0.13.5) of Python (Version 3.1) was used for all statistical analyses. Results: 5,909 male participants with prostate cancer met the inclusion criteria. 2,280 (38.58%) had completed the SDOH surveys and were considered for analysis. Of those, 1,966 (86%) were White, 5.88% Black or African American, and 3.55% Hispanic in ethnicity. In the ordinal logistic regression models, for every unit increase in the SDOH neighborhood characteristics score, the odds of having a higher perception of general health increased by 3% (OR 1.03, 95% CI = [1.02, 1.04], p < 0.0001). For every unit increase in the SDOH day-to-day discrimination score, the odds of having a higher perception of general health increased by 3% (OR 1.03, 95% CI = [1.02, 1.04], p < 0.0001). For every unit increase in the score of the supportive relationships SDOH domain, participants were 4% (OR = 1.04, 95% CI = [1.035, 1.053]) more likely to have a higher perception of general health. Controlling for all other variables, Black race, Hispanic ethnicity, a history of mental health disorders, smokers, and age less than 65 years were independently significant for poor perception of overall health (p < 0.05). Conclusions: While SDOH have been linked with prostate cancer-specific mortality, this is one of the first studies evaluating the role of each component of SDOH on the perception of overall health. We highlighted that factors including neighborhood, discrimination, and supportive relationships have a quantifiable impact on health. Our study provides objective predictive changes in the overall perception of health. Using our variables as a model to predict the effect of changes in these determinants and tailor support to individual needs could ultimately improve quality of life.