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Social Determinants of Cancer Risk Among American Indian and Alaska Native Populations: An Evidence Review and Map
Stephanie C Melkonian1, Jolie Crowder2, Emily E Adam3,4
1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico, USA.
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.
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