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. 2026 Jan 29;10(8):2801–2816. doi: 10.1182/bloodadvances.2025017559

Understanding the impact of social determinants of health in hematology: a scoping review of trends across journals and over time∗

Bonnie Lu 1, James Troyer 2, Kate J Krause 3, Ajibike Lapite 4, Melanie Aviles 5, Sherraine Della-Moretta 6, Dre’Von Dobson 7, Kaveh Farrokhi 8, Zainul S Hasanali 9, Pallavi Pillai 10, Cristian Taborda 11, Lynda Villagomez 12, Phuong T Vo 13,14, Ruth W Wang’ondu 15, Jennifer C Yui 16, Angela C Weyand 17, Warren B Fingrut 18,∗
PMCID: PMC13122809  PMID: 41587417

Abstract

Addressing social determinants of health is increasingly recognized as a critical priority in medicine to optimize care delivery to all patients. To support health care providers, researchers, and the hematology field to process and synthesize the rapidly expanding hematology social determinants of health literature, we conducted a scoping review to catalog/describe recent hematology social determinants studies. Our goals were to highlight state of the art in hematology social determinants research, describe trends in this literature across journals/conferences and over time, identify gaps, and inspire efforts to improve health across populations. Our search returned 602 hematology articles and 153 abstracts. Most works examined racial or socioeconomic disparities among adults with hematologic malignancies or who are hematopoietic cell transplant/cell therapy recipients. In contrast, few explored basic science correlates of disparities, approaches to optimize collection, recording, reporting, and use of social determinants of health data, or interventions/educational initiatives to address care inequities. Many vulnerable populations were understudied, including Indigenous peoples; people living with disabilities; transgender/gender-nonbinary peoples; and disparities across parity, religion, or immigration/legal status. Only a minority of works considered intersectionality across multiple dimensions of disparities. Although both the number and proportion of social determinants studies increased over time, there were imbalances in journals in which these studies were published. Overall, this review is an important tool to advance hematology population health, highlight hematology social determinants of health research productivity, inform development of research agendas and priorities for societies/funders, and support researchers to address identified gaps. Closing these gaps will be essential to improve delivery of safe and effective hematologic care for all.

Introduction

Addressing patients’ social determinants of health is increasingly recognized as a critical priority in medicine, to optimize delivery of safe and effective health care across populations. To support health care providers, researchers, and the hematology field to process and synthesize the rapidly expanding hematology social determinants of health literature, our team set out to conduct a scoping review of recent hematology social determinants of health literature, including articles published across all major hematology/oncology/medicine/pediatric journals as well as conference proceedings of major adult and/or pediatric hematology/oncology societies. Our goals were to highlight the state-of-the-art articles in hematology social determinants of health research, and to describe trends in the literature by study type, topic, population, disease site, and social determinant examined, across journals, and over time. We also sought to identify gaps for which further research is needed and inspire efforts to spearhead projects characterizing and addressing disparities related to the social determinants of health.

Methods

For this review, we defined disparities as differences in disease presentations/features, care delivery, and/or health outcomes, which were related to the social determinants of health. We conceptualized these disparities as inequities (ie, preventable and unjust).

We developed a scoping review protocol and registered it in Open Science Framework (https://osf.io/exuzc). We adhered to PRISMA (preferred reporting items for systematic reviews and meta-analyses) extension guidelines.1 Our review team included members with expertise in hematology, population health, and the social determinants of health, as well as a medical librarian specializing in systematic reviews (K.J.K.). Team members also drew upon their experience developing and describing the American Society of Hematology (ASH) Health Equity Compendium (https://ashpublications.org/collection/41840/Health-Equity-Compendium)2, a collection of health equity articles published recently to the Blood family journals. This expertise informed all stages of the review, guiding the development of the scoping review protocol and search strategy, coding framework, and data extraction.

Journal and conference proceedings selection

This scoping review examined works related to hematology and the social determinants of health, which were published across leading journals and major conference proceedings relevant to the hematology field. This approach was selected to focus on works with the greatest visibility, accessibility, and influence, reflecting what clinicians, researchers, and funders would be most likely to encounter and read. The review team generated a list of journals for the medical librarian to search, including all official journals of major hematology/oncology societies in the United States and Europe, as well as other journals in the fields of hematology, oncology, general medicine, and pediatrics which were listed in the first quartile of Clarivate’s Journal Citation Reports. The review team also selected 10 hematology/oncology conferences for manual abstract review. These conferences were selected by the team through consensus discussions, based on meeting size (typically >2000 attendees), breadth of hematology populations (including adult and pediatric) and subtopics represented, and geographic reach (see supplemental Table 1A-B for list of included journals and conferences).

Search development and strategy

To facilitate the search, our team assembled a list of social determinants of health keywords and subject headings, applying our experience conducting a similar search of Blood family journals2 to collate search terms that would identify population health works across vulnerable or special populations while limiting nonrelevant articles to the maximum degree possible (see supplemental Table 2 for the complete list of keywords/subject headings). The medical librarian then used these keywords and subject headings, as well as the list of selected journals, to design the search strategy. The search retrieved articles published from 1 January 2018 to 23 March 2024 (±2 weeks), which contained ≥1 social determinant of health keyword or subject heading. The start date of 1 January 2018 was selected to ensure this review reflected the recent hematology social determinants of health literature. Searches were restricted to the English language for feasibility and excluded conference materials, which were searched manually, as described hereafter.

We identified 21 hematology journals that met our journal inclusion criteria and searched each journal individually using OVID Medline and Embase. We also identified 46 oncology/medicine/pediatric journals that met our journal inclusion criteria and used the same search string plus ≥1 hematology term (see supplemental Table 3). Supplemental Tables 4 and 5 show the complete search strings. Additional articles were identified by J.T. and W.B.F. through citation chaining.

To permit description and analysis of social determinants of health research works currently in development, ≥2 reviewers (B.L./J.T./W.B.F.) searched abstracts published in each conference proceedings of the last 2 meetings of 10 major adult/pediatric hematology/oncology societies from 1 May 2022 to 30 April 2024.

Article/abstract selection

At least 2 authors (B.L./J.T./M.A./S.D.-M./D.D./K.F./Z.S.H./A.L./P.P./C.T./L.V./P.T.V./R.W.W./J.C.Y./W.B.F.) independently reviewed/screened each citation’s title/abstract. Discrepancies were resolved by 2 authors (J.T./W.B.F.). All potentially relevant citations were included in the full-text screening. At least 2 authors (B.L./J.T./W.B.F.) independently screened the full-text articles, with discrepancies resolved by a third. Articles and abstracts were eligible if they focused on health equity in hematology, defined as characterizing and/or addressing disparities related to age, sex or parity (eg, nulliparity vs multiparity), race and ethnicity, sexual orientation or gender identity, disability, religion, socioeconomic status (SES), geographic location (eg, rural-urban disparities), immigration status, or incarceration/legal history (see supplemental Table 6 for definitions for each category). Eligible populations included patients, donors of products of human origin (blood, stem cells), and the hematology workforce. Works were excluded if not primarily related to hematology and the social determinants of health or if focused on care delivery challenges related to frailty/comorbidity burden, underresourced/rare diseases, or global health (lower-/middle-income country disparities). Of note, studies conducted within lower-/middle-income countries were not excluded solely based on geography; research investigating disparities within a single lower-/middle-income country (eg, rural-urban disparities in Uganda3) was eligible and included. Works that mentioned a social determinant of health but did not examine disparities related to that determinant (eg, listing patient race and ethnicity in the demographics table of a clinical trial) were excluded.

Data abstraction

Data was extracted by ≥2 reviewers (B.L./J.T./M.A./S.D.-M./D.D./K.F./Z.S.H./A.L./P.P./C.T./L.V./P.T.V./R.W.W./J.C.Y./W.B.F.), using a predesigned online data collection form. Data extracted included each study's first author, title, journal, publication year, country of conduct; study topic (classified as previously described in the ASH Health Equity Compendium analysis2); study design; social determinant examined; disease site (classified per ASH abstract categories, https://www.hematology.org/meetings/annual-meeting/abstracts/abstract-review-categories); and partnership with community advocates. Data were quality checked by B.L. or J.T. and W.B.F.

Data analysis

Extracted data were published to a google sheet, with data for articles and abstracts reported/described separately (https://docs.google.com/spreadsheets/d/1aAPWibzc5Wf9_1a-AQ9Xu6iPbq21umJxZpSjVNa4Lrc).

We compared both the number of social determinants of health articles published in each journal and the proportion of social determinants of health articles of these journals’ total article outputs over the review period. We examined hematology social determinants of health trends over time for articles (2018-2020 vs 2021-2023) and abstracts (earlier vs later meetings during the review period). χ2 analyses (using R version 4.5.0) assessed differences in hematology social determinants of health publications over time.

Results

The search returned 5494 articles; 1009 underwent full-text screening with 602 hematology social determinants of health articles included in the review (Figure 1A). In addition, conference proceedings from the last 2 meetings of 10 major hematology/oncology societies 1 May 2022 to 30 April 2024 were reviewed manually, with 153 abstracts included in the review (Figure 1B).

Figure 1.

Figure 1.

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Study selection flow diagram. (A-B) PRISMA flow diagram illustrating the selection process for included (A) articles or (B) abstracts.

Table 1., Table 2., Table 3. lists the characteristics of the 602 included articles. These articles were published across 42 journals, with 536 articles published in 21 hematology journals, 45 in 12 oncology journals, 20 in 8 internal medicine journals, and 1 in a pediatric journal.4 Among the hematology journals examined, included social determinants of health articles published to those journals reflected 0.9% of these journals’ total article outputs over the review period.

Table 1.

Summary of included hematology social determinants of health articles

Article characteristics No. of articles, n (%)
Study topic
 Basic science correlates of disparities 39 (6)
 Social determinants of health and laboratory medicine 31 (5)
 Disease phenotype and outcome differences by patient demographics 283 (47)
 Access to care for underserved populations 107 (18)
 Diversity in clinical trials enrollment 37 (6)
 Improving processes for collecting, recording, and reporting data related to the social determinants of health 20 (3)
 Interventions to address equity issues 64 (11)
 Workforce disparities 20 (3)
 Educational initiative 1 (0.2)
Study design
 Basic science 34 (6)
 Retrospective 259 (43)
 Prospective 93 (15)
 Clinical trial 15 (2)
 Perspective/editorial 118 (20)
 Systematic review/meta-analysis 25 (4)
 Review paper 57 (9)
 Economic analysis 1 (0.2)
Study site
 Single center 143 (24)
 Multicenter 116 (19)
 Database 159 (26)
 N/A 184 (31)
Study population
 Focus on pediatrics/AYA 132 (22)
 Blood donors 45 (7)
 Stem cell donors 19 (3)
 Workforce 30 (4)
Social determinants of health
 Age 54 (9)
 Sex 87 (14)
 Parity 14 (2)
 Race and ethnicity 342 (57)
 Black 173 (29)
 Hispanic 59 (10)
 Asian 21 (3)
 Indigenous 12 (2)
 Middle Eastern 11 (2)
 SES 239 (40)
 Area-based measures 71 (12)
 Individual social barriers 116 (19)
 Individual financial barriers 159 (26)
 Geographic 65 (11)
 Sexual and gender minority 46 (8)
 Transgender 22 (4)
 Disability 5 (1)
 Immigration status 9 (2)
 Religion 8 (1)
 Incarceration 2 (0.3)
Consideration of intersectionality 179 (30)
Disease site examined
 Red cell physiology and disorders 57 (9)
 Leukocytes, inflammation, and immunology 10 (2)
 Hemostasis, thrombosis, and vascular wall biology 59 (10)
 Transfusion medicine 63 (10)
 Hematopoiesis 2 (0.3)
 Hematologic malignancy 251 (42)
 Transplantation, adoptive cell therapies, and gene therapies 121 (20)
 N/A (or multiple applicable disease categories) 39 (6)
Performed in Partnership with Community Advocates 6 (1)
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AYA, adolescent and young adult; SES, socioeconomic status; N/A, not applicable.

Table 2.

Geographic distribution of included hematology social determinants of health articles

Continent, n (%) Country Number of articles, n
Africa, n = 5 (1%) Nigeria 2
Somalia 1
South Africa and Zimbabwe 1
Tanzania and Uganda 1
Asia, n = 15 (2.5%) China 3
India 1
Israel 2
Japan 3
Korea 2
Pakistan 1
Saudi Arabia 1
Turkey 2
Europe, n = 55 (9%) Denmark 5
France 5
Greece 1
Hungary 1
Ireland 1
Italy 7
The Netherlands 8
Spain 2
Sweden 5
Switzerland 1
United Kingdom 12
United Kingdom and Ireland 1
Multiple European countries 6
North America, n = 447 (74%) Canada 27
Mexico 2
United States 412
United States and Canada 5
Jamaica 1
South American, n = 3 (0.5%) Argentina 1
Brazil 2
Oceania, n = 14 (2%) Australia 12
Australia and New Zealand 1
New Zealand 1
International 20
N/A 43
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N/A, not available.

Table 3.

Distribution of hematology social determinants of health articles by journal

Journals No. of articles, n (%)
Hematology (n = 536)
 American Journal of Hematology 24 (3.99)
 Blood 30 (4.98)
 Blood Advances 65 (10.80)
 Blood Cancer Journal 20 (3.32)
 Blood Reviews 6 (1.00)
 Bone Marrow Transplantation 20 (3.32)
 British Journal of Haematology 27 (4.49)
 Clinical lymphoma, myeloma and leukemia 38 (6.31)
 Critical Reviews in Oncology and Hematology 9 (1.50)
 Haematologica 13 (2.16)
 HemaSphere 5 (0.83)
 Hematology, ASH Education Program 5 (0.83)
 Journal of Hematology & Oncology 2 (0.33)
 Journal of Thrombosis and Haemostasis 16 (2.66)
 Leukemia 4 (0.66)
 Pediatric Blood & Cancer 77 (12.80)
 The Lancet Haematology 38 (6.31)
 Thrombosis and Haemostasis 10 (1.66)
 Thrombosis Research 19 (3.16)
 Transfusion 52 (8.64)
 Transplantation and Cellular Therapy∗ 56 (9.30)
Oncology (n = 45)
 American Society of Clinical Oncology Educational Book 3 (0.50)
 CA: A Cancer Journal for Clinicians 1 (0.17)
 Cancer Discovery 1 (0.17)
 Clinical Cancer Research 1 (0.17)
 JAMA Oncology 2 (0.33)
 JCO Clinical Cancer Informatics 2 (0.33)
 JCO Global Oncology 2 (0.33)
 JCO Oncology Practice 20 (3.32)
 Journal for ImmunoTherapy of Cancer 1 (0.17)
 Journal of Clinical Oncology 7 (1.16)
 Journal of the National Cancer Institute 4 (0.66)
 Trends in Cancer 1 (0.17)
Internal medicine (n = 20)
 Annals of Internal Medicine 1 (0.17)
 eClinicalMedicine 1 (0.17)
 JAMA 3 (0.50)
 JAMA Internal Medicine 2 (0.33)
 JAMA Network Open 7 (1.16)
 Medical Journal of Australia 1 (0.17)
 New England Journal of Medicine 2 (0.33)
 The Lancet 3 (0.50)
Pediatric (n = 1)
 The Lancet Child and Adolescent Health 1 (0.17)
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ASH, American Society of Hematology; JAMA, Journal of the American Medical Association; JCO, Journal of Clinical Oncology.

∗

Includes articles published in Biology of Blood and Marrow Transplantation.

The median number of social determinants of health articles published during the review period per hematology journal was 20 (range, 2-77), with the highest numbers published in Pediatric Blood & Cancer (n = 77), Blood Advances (n = 65), and Transplantation and Cellular Therapy (n = 56; Figure 2A). The highest proportions of articles were published in Lancet Haematology (3.34%), Transplantation and Cellular Therapy (2.33%), and Blood Cancer Journal (2.14%; Figure 2B).

Figure 2.

Figure 2.

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Trends in SDOH articles across hematology journals. (A) Scatterplot illustrating the percentage of SDOH articles by journal size. Number of SDOH articles published by a journal over the study time period is represented by the circle size. (B) Heat map showing the percentage of SDOH articles by time period (early, 2018-2020 vs recent, 2021-2023), The color gradient denotes percentage of SDOH articles. SDOH, social determinants of health. Figure created with R version 4.5.2.

Most articles (510/602 [85%]) focused on patients, with 64 (11%) about blood (n = 45) or stem cell (n = 19) donors, and 30 (5%) on the hematology workforce. One-fifth (132/602 [22%]) focused on pediatric or adolescent and young adult patients. Overall, by study design, 33 of 602 (6%) were basic science studies. Of 602 studies, 367 (61%) were clinical studies, of which over two-thirds (259/367 [71%]) were retrospective, with less than one-third (108/367 [29%]) prospective. Only 15 were clinical trials. One-third of included articles (200/602 [33%]) were perspectives/editorials (118/602 [20%]), review papers (57/602 [9%]), or systematic reviews/meta-analyses (25/602 [4%]). A single economic analysis was included.5 Of 367 (61%) retrospective/prospective patient studies, one-third each were single-center, multicenter, or database studies.

Most articles focused on the United States (n = 417) and/or Canada (n = 32), with the remainder on Europe (n = 55, 13 from the United Kingdom), Asia (n = 15), Australia/New Zealand (n = 14), South/Central America (n = 6), Africa (n = 5), or multiple countries (n = 20).

Analysis by article topic

Classifying by topic, the highest proportions of articles studied disease phenotype and outcome differences by patient demographics (239/602 [40%]). One-fifth studied access to care for underserved populations (107/602 [18%]), focusing on barriers to disease screening/diagnosis, therapies/transplantation, blood/stem cell donation, electronic communication with the health care team, medication adherence, and emergency, follow-up, or palliative/hospice care.

Overall, 64 articles (11%) discussed interventions to address equity issues. Of these, the greatest number of articles focused on diversifying blood/stem cell donor bases (by race and ethnicity and/or to include sexual/gender minority [SGM] donors, n = 14), addressing social and/or financial challenges with care (eg, through financial navigation, community health care worker support, use of health literacy/informed consent tools, approaches to care for uninsured/underinsured patients, and use of electronic health tools to optimize medication adherence (n = 12), and novel transplant platforms/use of HLA-disparate grafts to extend transplant access (n = 11). Other interventions outlined approaches to care for Jehovah's Witnesses with hematologic conditions (n = 4)6, 7, 8, 9; improve community outreach/engagement and/or use of telemedicine to enhance access to care or clinical trials enrollment (n = 3)10, 11, 12; consider sex in clinical decision-making (n = 3)13, 14, 15; improve hemophilia care for women, girls, and people who menstruate (n = 2; eg, revised disease classification, novel therapies)16,17; extend access to care for older adults (n = 2; eg, chimeric antigen receptor T-cell therapy or venous thromboembolism prophylaxis)18,19; or optimize therapies of limited supply for patients from underserved populations (n = 2; eg, chimeric antigen receptor T-cell therapy slots, Rh-negative blood).20,21 A single intervention focused on the hematology/oncology workforce (through diversifying fellowship applicants).22 Ten articles reviewed ongoing efforts to address disparities (in trial enrollments, transplant access, pregnancy hematologic management, and refugee care).

Of 602 studies, 38 (6%) papers that studied basic science correlates of disparities, nearly all focused on genetic differences in disease biology (n = 31) or pharmacogenetics (n = 3) by ethnic/ancestral population. One each focused on sex differences in disease biology,23 metabolism in people receiving gender-affirming hormone-replacement therapy,24 transcriptomics in patients facing low SES,25 and ethnic/ancestral differences in neutrophil biology26 or thrombotic profiles.27

Other articles studied diversity in clinical trials enrollment (37/602 [6%], nearly all related to race and ethnicity and/or SES) or social determinants of health in laboratory medicine (31/602 [5%]), including articles calling for the elimination of race or sex-based reference ranges (in hemoglobin,28 ferritin,29 neutrophil count,30 pulse oximetry interpretation31) or advocating for sexual and gender minority inclusion in donation.32 Twenty (3%) focused on processes to collect/record/report social determinants of health data, including with respect to race and ethnicity,33 sexual orientation/gender identity,34 or social/financial challenges.35 Twenty (3%) studied workforce disparities, including gender differences in faculty rank/leadership positions,36 article/guideline authorship,37 invited lectureships,38 question-asking at conferences,39 caregiving and academic success,40 or discrimination/bias in fellowship selection or grant application scoring.41 Only 1 described an educational initiative (on mitigating bias).42

Analysis by disease site

By disease site, of 563 disease-related articles, two-thirds (66%) examined hematologic malignancies (251/563 [45%]) or transplantation/adoptive cell therapies/gene therapies (121/563 [20%], including 102 studying allogeneic and/or autologous transplantation, 15 studying cell therapy, 3 transplantation and cellular therapies, and 1 studying gene therapy43). A further 63 of 563 (11%) studied transfusion medicine (including blood donor inclusion/recruitment/care, blood use, and recipient care), 59 of 563 (10%) studied hemostasis/thrombosis/vascular wall biology (including immune thromobcytopenia, thrombotic thrombocytopenia purpura, von Willebrand disease, hemophilia, and venous thromboembolism/anticoagulation), 57 of 563 (10%) studied red cell physiology/disorders (including sickle cell disease, thalassemia, or iron/B12/glucose-6-phosphate deficiency), 10 of 563 (2%) studied leukocytes/inflammation/immunology (all on Duffy-null–associated neutrophil count), and only 2 studies were on hematopoiesis (both about clonal hematopoiesis).23,44

Analysis by social determinants of health

With respect to social determinants examined, over half of the articles (342/602 [57%]) characterized racial and ethnic disparities, with 173 focusing on Black, 59 Hispanic, 21 Asian, 12 Indigenous, and 11 Middle Eastern peoples.

Of 239 (40%) articles related to SES, one-third (71/239 [30%]) focusing on area-based measures (eg, neighborhood poverty), two-thirds (159/239 [66%]) on individual financial barriers (eg, insurance status and cost-of-living or medical expense financial support), and half (116/239 [49%]) examined individual social barriers (eg, marital or cohabitation status, health literacy, caregivers, and educational attainment).

Fifty-four (9%) publications examined age and 87 (14%) sex, with only 14 examining parity. Sixty-five (11%) examined geographic disparities. Forty-six (8%) focused on sexual and gender minorities, with 22 focusing on transgender or gender-nonbinary peoples. Only 8 focused on immigration status disparities (5 on red cell disorders,45, 46, 47, 48, 49 2 on cancer care,50,51 and 1 on blood donation52), 8 on religion6, 7, 8, 9,53, 54, 55, 56 (all related to care of Jehovah’s Witnesses with hematologic malignancies), and 2 on incarceration/legal history (1 on donation equity57 and 1 on cause of death inappropriately listed as sickle cell trait58).

Overall, 179 of 602 (30%) publications considered intersectionality across multiple disparities, with half of these examining intersections among ≥3 variables. The most common intersectional considerations were race and ethnicity with SES (n = 65), with 28 of these additionally examining geographic location. Only 6 (1%) described partnership with patient/community advocates to address disparities (4 focusing on race and ethnicity and/or SES,59, 60, 61, 62 and 2 on SGM63,64).

Trends in population health publications over time

Table 4 outlines the distribution of hematology social determinants of health articles published in hematology journals (n = 536), overall and by time period. When analyzing by period, social determinant of health–related outputs increased over time, with twice as many articles published in the later (2021-2023, n = 356) vs earlier (2018-2020, n = 189) period (P < .001) and a further 57 (9% of included articles) published in the first 3 months of 2024. Furthermore, when considering all articles published to the 21 hematology journals from 2018 to 2023, these journals published a much higher proportion of social determinants of health articles in the later vs earlier periods (177/20827 [0.85%] vs 314/22385 [1.4%]; P < .001). By journal, Critical Reviews in Oncology and Hematology published 10 times as many articles in the recent vs earlier period; with 4 times as many in Hematologica; 3 times as many in Blood Advances, Journal of Thrombosis and Hemostasis, and Thrombosis Research; and twice as many in Blood Reviews and Transplantation and Cellular Therapy/Biology of Blood and Marrow Transplantation. In Leukemia and Hemasphere, social determinants of health articles were only published in the recent periods. Conversely, only Bone Marrow Transplantation and British Journal of Hematology saw decreased proportions of social determinants of health articles published in recent years.

Table 4.

Distribution of hematology social determinants of health articles published to hematology journals (n = 536), overall and by time period

Hematology journal 2018- 2020
 2021-2023
 Total (2018-2023)
n % of all articles published to the journal∗ n % of all articles published to the journal∗ n % of all articles published to the journal∗
American Journal of Hematology 9 0.89 14 1.29 23 1.10
Blood 12 0.45 18 0.65 30 0.55
Blood Advances 12 0.73 43 2.04 55 1.47
Blood Cancer Journal 8 2.20 12 2.11 20 2.14
Blood Reviews 1 0.64 3 1.29 4 1.03
Bone Marrow Transplantation 10 1.05 9 0.85 19 0.94
British Journal of Haematology 18 0.87 8 0.41 26 0.64
Clinical Lymphoma, Myeloma and Leukemia 11 4.66 23 5.40 34 5.14
Critical Reviews in Oncology and Hematology 2 0.36 6 3.57 8 1.11
Haematologica 2 0.13 8 0.63 10 0.36
HemaSphere 0 0.00 5 1.06 5 0.64
Hematology, ASH Education Program 2 0.78 3 1.60 5 1.12
Journal of Hematology & Oncology 1 0.22 1 0.20 2 0.21
Journal of Thrombosis and Haemostasis 3 0.29 11 0.94 14 0.63
Leukemia 0 0.00 4 0.35 4 0.18
Pediatric Blood & Cancer 31 1.81 39 2.01 70 1.92
The Lancet Haematology 6 1.28 30 4.92 36 3.34
Thrombosis & Haemostasis 4 0.60 5 0.79 9 0.69
Thrombosis Research 5 0.43 12 1.16 17 0.78
Transfusion 21 1.38 28 1.88 49 1.63
Transplantation and Cellular Therapy† 19 1.63 32 3.13 51 2.33
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∗

The proportion of hematology social determinants of health articles published in each journal relative to the total number of articles published in that journal during the specified time frame.

†

Includes articles published in Biology of Blood and Marrow Transplantation.

Table 5 summarizes characteristics of included hematology social determinants of health articles by period. By study topic, notably, compared with the earlier period (2018-2020), the later period (2021-2023) included 5 times the proportion of articles focusing on diversity in clinical trials enrollment, as well as greater proportions of articles on access to care for underserved populations, interventions to address disparities, workforce disparities, and social determinants of health in laboratory medicine. By study design, the later period included higher proportions of prospective studies/trials (with a greater proportion being multicenter), and perspectives/editorials/systematic reviews/meta-analyses. In the later period, a smaller proportion of articles focused on pediatric/adolescent and young adult patients, and a greater proportion studied the hematology/oncology workforce. In the later period, a higher proportion of included articles considered intersectionality across multiple disparities, resulting in a higher proportion of articles discussing nearly every social determinant of health (except religion and immigration status). Notably, the later period included >5 times the proportion of articles discussing parity, and higher proportions focusing on Black, Hispanic, Asian, and Indigenous populations, and over twice the proportion of SES analyses considering area-based measures. Articles on disability (n = 5)65, 66, 67, 68, 69 or incarceration (n = 2)57,58 were only present in the later periods. The proportions of articles by disease examined were similar over time.

Table 5.

Summary characteristics of included hematology social determinants of health articles by time period

Study characteristics 2018-2020, n = 189; n (% by time period) 2021-2023, n = 356; n (% by time period)
Study topic
 Basic science correlates of disparities 17 (9) 19 (5)
 Social determinants of health in laboratory medicine 10 (5) 19 (5)
 Disease phenotype and outcome differences by patient demographics 98 (52) 158 (44)
 Access to care for underserved populations 31 (17) 64 (18)
 Diversity in clinical trials enrollment 3 (2) 31 (9)
 Improving processes for collecting, recording, and reporting data related to the social determinants of health 8 (4) 10 (3)
 Interventions to address equity issues 16 (8) 42 (12)
 Workforce disparities 5 (3) 13 (4)
 Educational initiative 1 (0.5) 0 (0)
Study design
 Basic science 15 (8) 16 (4)
 Retrospective 88 (47) 148 (42)
 Prospective 28 (15) 54 (15)
 Clinical trial 4 (2) 9 (3)
 Perspective/editorial 31 (17) 79 (22)
 Systematic review/meta-analysis 4 (2) 18 (5)
 Review paper 19 (10) 31 (9)
 Economic analysis 0 (0) 1 (0.3)
Study site
 Single center 51 (27) 75 (21)
 Multicenter 30 (16) 77 (22)
 Database 55 (29) 91 (26)
 N/A 53 (28) 113 (32)
Study population
 Focus on pediatrics/AYA 46 (24) 72 (20)
 Blood donors 16 (8) 26 (7)
 Stem cell donors 7 (4) 10 (3)
 Workforce 7 (4) 20 (6)
Social determinants of health
 Age 16 (8) 33 (9)
 Sex 23 (12) 58 (16)
 Parity 1 (0.5) 10 (3)
 Race and ethnicity 99 (52) 207 (58)
 Black 50 (26) 107 (30)
 Hispanic 16 (8) 37 (10)
 Asian 6 (3) 13 (4)
 Indigenous 3 (2) 8 (2)
 Middle Eastern 4 (2) 6 (2)
 SES 73 (39) 141 (40)
 Area-based measures 13 (7) 47 (13)
 Individual social barriers 42 (22) 63 (18)
 Individual financial barriers 44 (23) 97 (27)
 Geographic 16 (9) 42 (12)
 Sexual and gender minority 13 (7) 30 (8)
 Transgender 7 (4) 14 (4)
 Disability 0 (0) 3 (1)
 Immigration status 6 (3) 2 (0.5)
 Religion 7 (4) 1 (0.3)
 Incarceration 0 (0) 2 (0.5)
Consideration of intersectionality 43 (23) 114 (32)
Disease site examined
 Red cell physiology and disorders 19 (10) 35 (10)
 Leukocytes, inflammation, and immunology 4 (2) 5 (1)
 Hemostasis, thrombosis, and vascular wall biology 19 (10) 35 (10)
 Transfusion medicine 25 (13) 34 (10)
 Hematopoiesis 0 (0) 2 (0.5)
 Hematologic malignancy 75 (40) 147 (41)
 Transplantation, adoptive cell therapies, and gene therapies 36 (19) 71 (20)
 N/A (or applicable multiple disease categories) 11 (6) 27 (8)
Performed in partnership with community advocates 2 (1) 5 (1)
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Abbreviations are explained in Table 1.

Abstract analysis: examining social determinant of health works in development

The characteristics of included abstracts are summarized in Table 6. Overall, 153 hematology social determinants of health abstracts were published in conference proceedings of meetings by 10 major adult and/or pediatric hematology/oncology societies 1 May 2022 to 30 April 2024. Almost all abstracts (143/153 [93%]) were presented at ASH (116/153 [76%]) or Tandem (27/153 [18%]) meetings. The remaining 10 abstracts were presented to meetings of the American Society of Pediatric Hematology/Oncology (n = 5), Association for the Advancement of Blood & Biotherapies (n = 2), European Society for Medical Oncology (n = 2), and International Society of Pediatric Oncology (n = 1).

Table 6.

Summary of included hematology social determinants of health abstracts

Abstract characteristics Abstracts, n (%)
Study topic
 Basic science correlates of disparities 9 (6)
 Social determinants of health in laboratory medicine 11 (7)
 Disease phenotype and outcome differences by patient demographics 59 (39)
 Access to care for underserved populations 42 (27)
 Diversity in clinical trials enrollment 10 (7)
 Improving processes for collecting, recording, and reporting data related to the social determinants of health 8 (5)
 Interventions to address equity issues 8 (5)
 Workforce disparities 3 (2)
 Educational initiative 3 (2)
Study design
 Basic science 0 (0)
 Retrospective 107 (70)
 Prospective 35 (23)
 Clinical trial 8 (5)
 Perspective/editorial 0 (0)
 Systematic review/meta-analysis 2 (1)
 Review paper 1 (1)
 Economic analysis 0 (0)
Study site
 Single center 67 (44)
 Multicenter 30 (20)
 Database 49 (32)
 N/A 7 (5)
Study population
 Focus on pediatrics/AYA 31 (20)
 Blood donors 1 (1)
 Stem cell donors 6 (4)
 Workforce 7 (5)
Social determinant of health
 Age 20 (13)
 Sex 23 (15)
 Parity 1 (1)
 Race and ethnicity 91 (59)
 Black 29 (19)
 Hispanic 8 (5)
 Asian 0 (0)
 Indigenous 3 (2)
 Middle Eastern 0 (0)
 SES 77 (50)
 Area-based measures 35 (23)
 Individual social barriers 29 (19)
 Individual financial barriers 38 (25)
 Geographic 15 (10)
 Sexual and gender minority 3 (2)
 Transgender 2 (1)
 Disability 1 (1)
 Immigration status 0 (0)
 Religion 0 (0)
 Incarceration 0 (0)
Consideration of intersectionality 42 (27)
Disease site examined
 Red cell physiology and disorders 20 (13)
 Leukocytes, inflammation, and immunology 2 (1)
 Hemostasis, thrombosis, and vascular wall biology 3 (2)
 Transfusion medicine 3 (2)
 Hematopoiesis 1 (1)
 Hematologic malignancy 71 (46)
 Transplantation, adoptive cell therapies, and gene therapies 50 (33)
 N/A (or applicable multiple disease categories) 3 (2)
Performed in partnership with community advocates 16 (10)
Conferences presented
 ASH 116 (76)
 Tandem meetings 27 (18)
 American Society of Pediatric Hematology/Oncology 5 (3)
 Association for the Advancement of Blood and Biotherapies 2 (1)
 European Society for Medical Oncology 2 (1)
 International Society of Pediatric Oncology 1 (1)
Open in a new tab

Abbreviations are explained in Table 1.

By study topic, most analyzed disease phenotype/outcome differences by patient demographics (n = 59) or access to care (n = 42), with few studying social determinants of health data collection (n = 8), educational initiatives (n = 3),70, 71, 72 or workforce disparities (n = 3).73, 74, 75 By disease site, most (121/153 [79%]) studied hematologic malignancies (n = 71) and/or transplantation/cellular therapy (n = 50). Of 29 classical hematology abstracts, most studied red cell physiology/disorders (n = 20).

Two-thirds of abstracts examined racial and ethnic disparities (n = 102), with nearly one-third of these focused on Black populations. Few focused on Hispanic or Asian and none on Indigenous or Middle Eastern groups. Half (n = 77) assessed socioeconomic disparities, with less than one-fifth examining sex (n = 23 [15%]) or age (n = 20 [13%]). Only 3 abstracts focused on SGM,76, 77, 78 1 on disability,79 and 1 on parity.80 Intersectionality was considered in less than one-third (n = 42 [27%]) of abstracts, most commonly sex with race and ethnicity (n = 16) or SES (n = 14). Notably, one-tenth (n = 16) involved partnerships with community advocates. Analysis over time showed a >50% increase in social determinants of health abstracts published in the recent vs earlier meetings in the study period.

Discussion

This scoping review comprehensively examined how the social determinants of health have been studied recently within major journals and meetings across the field of hematology. The review considered the social determinants of health broadly, exploring works related to multiple social determinant domains across populations, and deeply, through searching multiple keywords and subject headings for each domain. The results highlight recent progress characterizing and addressing care delivery challenges affecting patients with hematologic diseases, as well as research in process, comparing across journals/meetings. The review identified multiple understudied areas warranting greater attention. Most works examined racial and/or socioeconomic disparities affecting adult patients with hematologic malignancies or who are hematopoietic cell transplant/cell therapy recipients in the United States. Notable gaps in the literature include the relative lack of studies investigating basic science correlates of disparities, including how unique social and environmental challenges (eg, chronic stress) can produce measurable molecular and immunologic effects, and the extent to which these effects affect patients with hematologic diseases. Furthermore, few studies examined approaches to optimize collection, recording, reporting and/or use of social determinants of health data, or interventions or educational initiatives to mitigate/address inequities. Few studies focused on classical hematologic conditions or specific underserved populations (including Indigenous peoples; people living with disabilities; transgender or gender-nonbinary peoples; or disparities across parity, religion, or immigration/legal status). Most articles did not consider intersectionality across multiple dimensions of disparities, and very few highlighted the patient voice or included patient/community advocates as research partners.

This review establishes benchmarks for hematology social determinants of health outputs, across journals and for the field overall. Nearly 1% of all articles published in the leading hematology journals over the review period focused on social determinants of health, with the number and proportion of social determinants of health articles increasing over time across nearly every journal examined. Our analysis also identified imbalances in which social determinants of health works are being published. This was particularly true for conference proceedings, with most social determinants of health abstracts presented at ASH/Tandem and few at the other meetings examined. Our data highlight the critical responsibility for editorial boards and conference organizing committees to build-in processes to encourage, solicit, include, and highlight quality submissions related to the social determinants of health.

Through this review, we generated a data set (https://docs.google.com/spreadsheets/d/1aAPWibzc5Wf9_1a-AQ9Xu6iPbq21umJxZpSjVNa4Lrc) that includes all extracted data from the articles and abstracts. This compendium reflects the state-of-the-art research in health disparities in hematology and is a resource that can be used to review and synthesize this rapidly expanding literature. Moreover, this data set is also a tool that can be used to conduct future analyses (eg, subset analyses by disease, population, article type, and/or social determinant of health).

We acknowledge the limitation that this scoping review only included works published in a predetermined set of leading journals and major meetings, most of which are in the United States and Europe. Additionally, our search used a nonexhaustive list of social determinants of health keywords that we assembled and previously tested,2 and excluded social determinants of health works focusing on environmental health, global health (ie, disparities affecting patients in lower-/middle-income countries)81,82 or understudied diseases,83 focusing on populations (eg, veterans,84 language minorities85) or published to journals70,86, 87, 88, 89, 90, 91, 92, 93 or meetings94, 95, 96, 97, 98 that were not included in the review, in languages other than English,99 and/or before100, 101, 102 or after103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119, 120, 121, 122 the review period. Additionally, it was not possible, in most cases, to determine whether a study examined race and ethnicity vs ancestry, or sex vs gender.

These limitations notwithstanding, this review is an important tool to advance population health in the field of hematology, to highlight recent hematology social determinants of health research accomplishments and productivity; inform development of research agendas and priorities for societies and funders; and connect social determinants of health researchers together to exchange ideas and collaborate, tackle common challenges,123, 124, 125, 126 and address identified gaps. Altogether, this analysis will help to improve delivery of safe and effective care across populations. Regular updates of this review will allow our field to track progress in social determinants of health research over time. Future work should also include qualitative analyses of the extracted literature to examine conceptual frameworks, methodological evolution, and thematic content in greater depth. Finally, similar reviews are warranted in areas across medicine, and these can apply the list of social determinants of health keywords that we have assembled and successfully piloted (supplemental Table 2) to screen for social determinants of health works in other journals.

Conflict-of-interest disclosure: P.P. is employed by Merck; however, her work on this scoping review was conducted separately from her employment. The remaining authors declare no competing financial interests.

Acknowledgments

Authorship

Contribution: W.B.F. conceived the review; J.T., K.J.K., and W.B.F. wrote the review protocol, with all authors reviewing and providing feedback; B.L., J.T., K.J.K., and W.B.F. designed the search; K.J.K. performed the search; B.L., J.T., M.A., S.D.-M., D.D., K.F., Z.S.H., A.L., P.P., C.T., L.V., P.T.V., R.W.W., J.C.Y., and W.B.F. performed title/abstract and/or full-text screening and data extraction using a predesigned online data collection form; B.L., J.T., and W.B.F. reviewed full texts of all included studies and quality checked extracted data; B.L., J.T., and W.B.F. performed the analysis and wrote the manuscript; and all authors reviewed, critically revised, and approved the final version of the manuscript.

Footnotes

∗

B.L. and J.T. contributed equally to this study.

The full-text version of this article contains a data supplement.

Supplementary Material

Supplemental Tables
BLOODA_ADV-2025-017559-mmc1.pdf (219.1KB, pdf)

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