Social Determinants of Cancer Risk Among American Indian and Alaska Native Populations: An Evidence Review and Map

Abstract

Objectives: To explore current literature on social determinants of health (SDOH) and cancer among American Indian and Alaska Native (AI/AN) populations. Methods: We searched Ovid MEDLINE ® , CINAHL, and PsycINFO databases for articles published during 2000 to 2020, which included terms for SDOH and cancer occurrence in AI/AN populations. We derived the data extraction elements from the PROGRESS-Plus framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Equity extension guided the evidence map. Results: From 2180 screened articles, 297 were included. Most were observational (93.9%), employed a cross-sectional design (83.2%), were categorized as cancer occurrence and surveillance research (62%), and included no cancer-related risk factors (70.7%). Race, gender, and place were the most frequently included PROGRESS-Plus categories. Religion, relationship features, and characteristics of discrimination were least common. Only 12% of articles mentioned historical/current trauma or historical context. Conclusions: Gaps exist in our understanding of SDOH as drivers of cancer disparities in AI/AN populations. Future studies in health equity science may incorporate historical and cultural factors into SDOH frameworks tailored for AI/AN populations.

Structural Racism and Lung Cancer Risk

“…46 Given the historical context of structural racism and its effects on American Indian and Alaska Native people, there is a need for rigorous study to evaluate how the domains of structural racism contribute to higher risk within this population. 47,48 For instance, research is needed to evaluate how inequities in high-quality housing and the geographic location of reservations may be associated with air quality, radon exposure, and secondhand smoke exposure. Additionally, for Asian and Native Hawaiian or Pacific Islander groups with notably high rates of non-smoking-related lung cancer, there is a particular need to better evaluate how structural racism may contribute to non-tobacco-related lung cancer risk, particularly in disaggregated ethnic populations.…”

“…This is particularly concerning given that American Indian or Alaska Native groups have significantly higher incidence rates of lung cancer compared with White individuals . Given the historical context of structural racism and its effects on American Indian and Alaska Native people, there is a need for rigorous study to evaluate how the domains of structural racism contribute to higher risk within this population . For instance, research is needed to evaluate how inequities in high-quality housing and the geographic location of reservations may be associated with air quality, radon exposure, and secondhand smoke exposure.…”

Melanoma Incidence Rates Among Non-Hispanic American Indian/Alaska Native Individuals, 1999-2019

“…33,34 Contextual factors facing many American Indian/Alaska Native people also likely play a role in late-stage diagnoses. 35 Lack of transportation, lack of time off from work, family care responsibilities, and other factors may be associated with receipt of a timely diagnosis. [35][36][37] Given these challenges, multicomponent community-based interventions may be needed to address the melanoma burden.…”

“…35 Lack of transportation, lack of time off from work, family care responsibilities, and other factors may be associated with receipt of a timely diagnosis. [35][36][37] Given these challenges, multicomponent community-based interventions may be needed to address the melanoma burden. 38 Similar to national findings for melanoma, 2 non-Hispanic American Indian/Alaska Native men had a higher burden of melanoma compared with non-Hispanic American Indian/Alaska Native women, particularly men 55 years and older.…”

“…Additionally, fewer American Indian/Alaska Native people report receiving a skin examination . Contextual factors facing many American Indian/Alaska Native people also likely play a role in late-stage diagnoses . Lack of transportation, lack of time off from work, family care responsibilities, and other factors may be associated with receipt of a timely diagnosis .…”