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Equity and Cancer Survival Among Veterans Health Administration Patients: A Systematic Review and Meta-Analysis
Alyssa Jasmine Bullard1, Haley I Tupper2, Kevin Su1
1Cooperative Studies Program Epidemiology Center-Durham, Durham Veterans Affairs Health Care System, Durham, North Carolina.
JAMA Network Open
|July 2, 2026
Summary
Black veterans in the Veterans Health Administration (VHA) system experienced similar or better cancer survival rates compared to White veterans. This suggests integrated health systems can reduce cancer outcome disparities.
Area of Science:
- Oncology
- Health Services Research
- Health Disparities
Background:
- Racial disparities in cancer survival are well-documented in the US, with Black patients experiencing worse outcomes than White patients.
- It remains uncertain whether these disparities persist within the Veterans Health Administration (VHA), an integrated healthcare system designed for equitable access.
Purpose of the Study:
- To evaluate differences in overall survival (OS) and cancer-specific survival (CSS) between Black veterans and veterans of other races receiving cancer care within the VHA.
Main Methods:
- A systematic review and meta-analysis of studies published between January 2015 and April 2022, identified via PubMed and reference list reviews.
- Included studies focused on US veterans receiving VHA cancer care, reporting OS or CSS by race with hazard ratios (HRs).
- A random-effects model was employed for meta-analysis following PRISMA guidelines.
Main Results:
- The analysis included 29 studies representing 603,256 veterans, with a mean of 29.0% categorized as Black.
- Black veterans demonstrated better OS (HR, 0.93; 95% CI, 0.89-0.97) and CSS (HR, 0.94; 95% CI, 0.90-0.98) compared to White or non-Black veterans.
- Survival advantages for Black veterans were noted across multiple cancer types, including bladder, lung, and prostate cancers, with low to moderate heterogeneity.
Conclusions:
- In the VHA system, Black veterans generally had similar or better cancer survival outcomes compared to White or non-Black veterans.
- These findings indicate that integrated healthcare systems offering equitable access to comprehensive cancer care can significantly mitigate or eliminate cancer outcome disparities.
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