The role of structural racism in shaping urologic outcomes

Structural racism is increasingly recognized as a fundamental driver of racial and ethnic health disparities, yet it remains insufficiently addressed in research. This review examines persistent disparities in urologic outcomes across malignant and benign conditions and highlights the role of upstream inequities and policies that shape care.

The literature links structural racism to inequities across several domains, including screening policy and guideline implementation, referral patterns, subspecialty access, insurance design, and neighborhood-level factors such as redlining and environmental toxin exposure. In prostate cancer, race-neutral screening guidance contributes to delayed diagnosis and worse outcomes for black men. In bladder and kidney cancers, disparities persist in timeliness and quality of management, including delayed diagnoses and guideline discordant care. For benign conditions, particularly nephrolithiasis, benign prostatic hyperplasia (BPH), and prolapse disease, structural factors are associated with delays to definitive treatment, differential pain management, and variable access to advanced surgical care.

Structural racism should be treated as a causal determinant in urologic outcomes research and targeted with upstream interventions. Clinically, standardizing pathways, improving equitable access to specialty care, and auditing guideline concordant treatment can reduce avoidable disparities. Advancing rigorous methodology and testable frameworks is essential to identify and disrupt structural mechanisms of racial inequity in urologic outcomes.