Table 2.
Social determinants of health measured and cancer screening outcomes by cancer screening type in each study of cancer prevention among people with HIV in the United States, 2010–2024
| Cancer screening measures | Social determinant of health domains based on healthy people 2030, quantitative measures | |||||||
|---|---|---|---|---|---|---|---|---|
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| Author (year) | Cancer screening type assessed | Cancer screening outcome | Outcome assessment method | Economic stability | Education access and quality | Healthcare access and quality | Neighborhood and built environment | Social and community context |
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| Anal cancer screening | ||||||||
| Apaydin (2018) | HRA | HRA Follow-up within 6 months: 64% Transitions from HSIL to < HSIL | EHR abstracted | Annual household income ($20–29,999, $30–49,999, $50–79,000, $80–120,000, > $120,000) | Educational attainment (high school graduate, college graduate, post-graduate) | Health insurance (private, public, Medicare) Healthcare system inefficiencies Patient-provider relationship | X | Gender identity (male) Sexual orientation (gay, bisexual) Relationship status (single, in a relationship with a male partner, living with a male partner, married to a male partner) Internalized stigma Societal stigma |
| Cachay (2018) | Anal cytology | HSIL Prevalence: 14% | EHR abstracted | X | X | X | X | Sexual behavior (MSM, heterosexual) Drug user (Injection drug use, yes/no) |
| Cachay (2023) | Anal cytology | Anal Cytology Uptake: 49.8% HSIL Prevalence: 12% | EHR abstracted | X | X | X | X | Gender identity (cisgender, transgender) Sexual behavior/orientation (MSM, heterosexual) Drug user (injection drug use yes,no) |
| Cruz (2023) | Anal cytology HRA | Anal Cytology Uptake: 51% HRA Uptake: 19% |
Self-reported via survey | Annual income (< $15,000 vs. > $15,000) | Educational attainment (more than high school, high school or less) | Insurance coverage (public, private) | X | Sexual orientation (heterosexual, homosexual, bisexual) Sexual behavior (MSM, MSW) Gender Identity (man, women, transgender) Relationship Status (married/living together, single/divorced/separated/ widowed) |
| D'Souza (2013) | Anal cytology | Anal cytology uptake: 85% | In-clinic assessment by study staff | Annual income (> $40,000 vs. $40,000/Unknown) | Educational attainment (College degree or higher, < College degree, Unknown) | X | X | Sexual behavior (MSM) |
| Hernandez (2013) | Anal swab for HPV | HPV Infection Prevalence: 92% Oncogenic HPV Infection: 80% | In-clinic testing | X | Educational attainment (Did not complete college, Completed college, Completed graduate school) | X | X | Injection drug use (Ever) Sexual behavior (MSM) |
| Hernandez (2024) | HPV testing HRA | Anal HSIL: 42% | In-clinic testing | Employment status (Employed full time, Employed part time, Retired, Other) Annual income ($0-47,999, $48,000-$83,999, $84,000 +) | Educational attainment (Less than college, Some college/technical school, Bachelor’s degree, Graduate or professional degree) | X | X | Gender Identity (male or transperson) |
| Junkins (2024) | Anal cytology | Anal screening prevalence: 52% | EHR abstracted | X | X | X | County Social Vulnerability (Lowest vulnerability, Low to moderate vulnerability, Moderate to high vulnerability, Highest vulnerability score) | Sexual orientation (homosexual, heterosexual, bisexual, other) |
| Kutner (2024) | HRA follow-up | Overdue for HRA by 2 years or more: 30.8% | EHR confirmed | Annual income (Below $29,999, $30,000–$59,999, $60,000-or more) | Educational attainment (< 2-year College Degree, 4-year College Degree, Masters or Doctoral Degree) | X | X | Gender Identity (cisgender male/female, transgender male/female, nonbinary, transgender) Sexual orientation (gay, bisexual, queer, heterosexual) Relationship status (single, casual dating, boyfriend/girlfriend/partner/lover) |
| Nyitray (2023) | DARE | Received DARE in the past year: 14% | Self-reported via survey | X | X | Insurance coverage (Yes, No) | X | Gender identity (man, transgender/non-binary, other) Sexual orientation (gay, bisexual, other) |
| Rim (2024) | Anal cytology | Anal cytology prevalence in past year: 5% | EHR abstracted | Employment status (Employed (for wages or self-employed), Unemployed or unable to work, Other employment status) Household income in past 12 months (Above federal poverty level, At or below federal poverty level) | Educational attainment (Less than high school, High school or equivalent, More than high school) | Insurance coverage (Any private insurance, Public only, Ryan White HIV/AIDS Program coverage only, Uninsured) Healthcare facility type (does not provide HRA, provides HRA, provides HRA through outside referral) |
Region (Western Medical Monitoring Project or MMP states, Midwestern MMP states, Northeastern MMP states, Southern MMP states, Puerto Rico) | Gender Identity (cisgender male, cisgender female, transgender female) Sexual orientation (lesbian, gay, heterosexual, bisexual, other) Sexual behavior (MSM) |
| Schwartz (2013) | Anal cytology Histology HPV HRA | HR-HPV Positive: 50% (< AIN2) AIN2 + : 29% |
In clinic testing | X | Educational attainment (High school, College, Graduate school) | X | X | Sexual behavior (MSM) |
| Wells (2018) | Anal cytology Anoscopy | Received Anal Cytology: 29% Abnormal cytology result: 69% Received Anoscopy: 35% | EHR abstracted | X | X | Insurance coverage (None, Medicaid, Medicare, Private, Other) | X | Sexual Behavior (MSM, non-MSM) Relationship Status (single/divorced/ widowed, married/live in partner, not documented) |
| Wells (2022) | Anal Cytology HRA | HSIL: 6% HRA within 6 months: 24% HRA within 12 months: 57% |
EHR abstracted | Current Employment status (No, Yes) Average Household Monthly income (< $1000, $1001–2500, $2501–6250, > $6250) Housing stability (Own home/apartment, Someone else’s home/apartment/ shelter, Homeless/correctional/ treatment facility) |
Educational attainment (High school diploma, High school diploma/ GED, Attended/ completed college, Attended/completed graduate school) | Health Insurance (Government (any), No coverage/self-pay, Other, Private health insurance) | X | Sexual orientation (heterosexual/straight, bisexual/other, lesbian/gay) Relationship (single/never married, married/ living together, divorced/married/ separated) HIV/AIDS-related stigma score Social support score |
| Ye (2021) | Anal cytology | Received anal cytology: 37% | EHR abstracted | Employment status (Unemployed, Disabled, Employed, Retired, Student) | X | X | X | Sexual orientation/behavior (Heterosexual, MSM) Gender identity (men, women, transgender people) Relationship Status (married/life partner, divorced/separated, singled, widowed) |
| Breast cancer screening | ||||||||
| Weinstein (2016) | Mammography | Adherence to mammography within 2 years of first screening: 50% | EHR abstracted | Employment status (Employed, In school) | Educational attainment (Less than high school education) | X | X | Nativity (Foreign born, US born) First language (Non-English speaking) Relationship status (Single) Drug use (never/ever) |
| Cervical cancer screening | ||||||||
| Baranoski (2011) | Cervical cytology | Pap test prevalence within 18 months: 53% | EHR abstracted | Employment Status (Unemployed/Disabled) Social service use (Healthcare for the Homeless program enrollee, yes/no) | Educational attainment (Did not complete high school) | Distance to care (Home distance from hospital, miles (< 2, 2- < 5, 5- < 10, ≥ 10); Home distances from hospital, range) Type of provider (ID trained, yes/ no) Number of visits with a male provider (> 75% of visits) |
X | Nativity (US born) First language (English speaking) Relationship status (married) Drug use (yes/no) |
| Baranoski (2012) | Colposcopy | Colposcopy within 6 months: 59% HSIL Prevalence: 12% |
EHR abstracted | Employment status (Unemployed, yes/no) | Educational attainment (High school graduate or higher education) | Insurance coverage (Uninsured, Medicaid, Medicare, private) Distance to care (Household 5 or more miles from hospital) Clinic facility type (gynecology clinic, HIV NP, other) | X | Nativity (US born) First language (English speaking) Relationship status (married) Drug use (yes/no) |
| Barnes (2018) | Cervical cytology HPV Colposcopy | Baseline screening prevalence: 44.3% Screening prevalence at 15 months: 58% Colposcopy prevalence: 60% | EHR abstracted | X | X | Insurance coverage (Payor Program (uninsured, fed-state government, Medicaid, Medicare, commercial)) | X | X |
| Bynum (2016) | Cervical cytology | Pap test/ screening uptake within 1 year: 81% Two or more pap tests within first year of HIV diagnosis: 36% Having pap tests after HIV diagnosis: 35% | Self-reported via survey | Employment status (full time/part time, unemployed) Annual income (< $10 k/year, ≥ $10 k/year), |
Educational attainment (no high school/GED, high school diploma/ GED, ≥ some college) | Type of provider (Personal healthcare provider, yes/no) Healthcare access (low access, high access) Transportation or getting to medical appointments (hard, easy) | X | Relationship status (married/partner, single) Perceived discrimination Perceived HIV Stigma (Stigma, no stigma) |
| Dailey-Garnes (2015) | Cervical cytology | Pap test/ screening within the past year: 52% | EHR abstracted | X | X | Number of primary care appointments (continuous measure) Type of care setting (specialty care, family practice) | Per capita income by zip code (< $12,000, 12–24,000, > $24,000) | Sexual orientation (heterosexual, yes/no) Drug use (intravenous drug use, yes/no) |
| Fletcher (2014) | Cervical cytology | Pap test/ screening uptake within the last year: 79% | Self-reported via survey | Employment status (Not working due to health, Not working for other reasons, Unable to find work) Annual Income (< $10,000 vs. ≥ $10,000) | Educational attainment (Less than high school, High school diploma/ General education development, Technical/vocational degree, Some college or two-year degree) | Insurance coverage (Medicare and/or Medicaid, No insurance) Patient-provider relationship Care coordination quality/referral process Transportation access Wait times | X | Drug use (injection drug use, yes/no) Relationship status (single, married) Religion (Christian, Muslim, other) |
| Fletcher (2014) | Cervical cytology | Pap test/ screening uptake within one year: 46% | EHR abstracted | Employment status (Working full or part time, Not working due to health, Unable to find work, Not working for other reasons) | Educational attainment (Less than high school, High school or equivalent, More than high school) | X | X | Drug use (injection drug use, yes/no; illicit drug use within the past 30 days, yes/no) Relationship status (married or living with partner, yes/no) Social support (ISEL) Perceived discrimination (Williams and colleagues' 9 item discrimination scale) |
| Frazier (2016) | Cervical cytology | Pap test/ screening uptake within the past year: 78% | Self-reported via survey | Poverty level (Above poverty level, At or below poverty level, Unknown) Homelessness (Yes/no) | Education attainment (< High school, High school diploma or GED, > High school) | Insurance coverage (Uninsured or lapse in insurance, yes/no) Patient-provider relationship (had 1:1 conversation with a health care professional, yes/ no) | X | Drug use (injection drug use, yes/no; any drug use, yes/no) Nativity (country of birth other than US or PR, yes/no) Incarceration (Yes/no) |
| Logan (2010) | Cervical cytology | Pap test/ screening uptake within one year: 83% | EHR abstracted | Annual income (Mean annual income) | X | Insurance coverage (Private, Need-based county plan, Medicaid, Medicare, Medicare/Medicaid, None (Ryan White only)) | X | Sexual orientation (Heterosexual contact, yes/no) Drug use (injection drug use, yes/no) History of Incarceration (yes/no) |
| Peprah (2018) | Cervical cytology | Prevalence of pap testing/ screening: 79% Abnormal pap test results: 40% | EHR abstracted | X | X | Insurance coverage (Public (Medicaid/Medicare), Private, Ryan White, Uninsured/ Out of pocket, Unknown) | X | Drug use (injection drug user, yes/no) |
| Soto-Salgado (2024) | Cervical cytology | Prevalence of pap test/ screening within the past 3 years: 92% | Self-reported via survey | Employment status (Currently employed, Other status, including women who are homemakers, retired, students, unemployed, and unable to work) Annual income (< $20,000, ≥ $20,000) | Educational attainment (< High school, High school diploma or GED, > High school) | Insurance coverage (Any private, Dual coverage Medicaid/Medicare or Medicare only, Medicaid or other public insurance, Uninsured including RWHAP only) Regular provider (has regular HIV provider, yes/no) | Region (Puerto Rico versus 22 other Medical Monitoring or MMP states) | HIV Stigma Discrimination (Experienced any healthcare discrimination scale) |
| Tello (2010) | Cervical cytology | No pap smear in the past year: 22% | EHR abstracted | Employment status (Full-time or part-time, Not working, Other or disability) | Educational attainment (< High school, High school/GED +) | X | X | Caretaker role of children (yes/no) Drug use (substance use, yes/no) Social Support (Very low-low, Medium, High) |
| Colorectal cancer screening | ||||||||
| Burkholder (2015) | Time to colorectal cancer screening at age 50 (defined as colonoscopy, flexible sigmoidoscopy, ACBE, or FOBT) | Prevalence of any colorectal cancer screening: 30% Median time to screening from age 50: 1.5 years | EHR abstracted | Insurance status (none, private, public) Regular external Primary provider (yes/no) |
Sexual behavior (MSM, yes/no) Drug use (substance use, yes/no) |
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| Kelly (2021) | Colorectal cancer screening | Prevalence of any colorectal cancer screening in the past 6 months: 30% | Self-reported via survey | X | Educational attainment (No formal schooling, Less than a high school diploma, A high school diploma or GED, Some college or a 2-year degree, 4-year college degree, Post-graduate work) | X | X | Relationship status (Married, yes/no) |
| Lam (2019) | Fecal test Sigmoidoscopy Colonoscopy | Prevalence of colorectal cancer screening in 1 year: 42% of PWH Prevalence in 5 years: 86% of PWH and 79% of those without HIV Prevalence of adenoma: 20% of PWH | EHR abstracted | X | X | Engagement in care (number of outpatient visits in year before start of follow-up, None to 3 or more) | X | X |
| Momplaisir (2012) | Colonoscopy Sigmoidoscopy Fecal occult blood test (FOBT) | Up to date with CRC screening: 47% Types of colorectal screening: 75% had colonoscopy, 14% had FOBT, and 10% had sigmoidoscopy | EHR abstracted | Poverty level (SES: Low SES-Yes, Low SES -No, Missing SES) | X | Insurance coverage (Medicaid, Other) Type of provider (Physician, Nurse practitioner or physician assistant) Clinic size (50–300 patients, > 300 patients) Facility type (Ryan white funded clinic, yes/no) |
X | Substance use (yes/no) |
| Lung cancer screening | ||||||||
| Islam (2023) | LDCT | LDCT follow-up within 1 year among PWH: 12% | EHR abstracted | X | X | Insurance type (Private insurance, Medicare, Others) Engagement in care (number of outpatient visits) | Area Level Poverty (< 10%, 10.1%-19.9%, ≥ 20.0%, Unknown) Rurality (Urban residence, Rural residence) |
X |
| Lopez (2022) | LDCT | LDCT referrals of those eligible: 9% LDCT Screening referral order completed: 55% LDCT uptake: 5% | EHR abstracted | Poverty level (Less than 100% of FPL, 100–200% of FPL, Over 200% FPL) | X | Insurance (Private, Medicare/Medicaid/VA, Ryan White/Pending/ None) Engagement in care (number of HIV care visits) | X | Sexual behavior (MSM, yes/no) Gender identity (transgender, yes/no) Drug use (illicit drug use, yes/no) |
| Triplette (2023) | LDCT | Prior LDCT/LCS exam: 28% | Self-reported via survey | Employment status (Fulltime, Part-time, Retired, Unemployed, Disabled, Other) Annual income (< $5,000, $5,000 – 15,000, $15,001 – 30,000, $30,001 – 50,000, $50,001 – 75,000, > $75,000) |
Educational attainment (Less than high school graduate, High school or GED, Some college, College degree, Graduate degree or professional school) | Insurance coverage (Private health insurance/ HMO, Medicare, Medicaid, Charity care/subsidized, Self-pay) | X | X |
| Prostate cancer screening | ||||||||
| Leapman (2022) | PSA Prostate biopsy | Ever PSA Testing prevalence: 76% of PWH | EHR abstracted | X | X | X | US Region (Northeast, West, Midwest, South) | Substance Use (yes/no) |
| Multiple cancer screening types | ||||||||
| Momplaisir (2014) | Colorectal cancer screening Mammography | Prevalence of guideline-concordant CRC screening: 54% of PWH Prevalence of guideline concordant mammogram in last year: 24% of PWH Prevalence of guideline concordant mammogram in five years: 42% of PWH | Self-reported via survey | Annual income (Low income, Yes/No/Missing income) | Educational attainment (0-11th grade, High school or GED, College or above) | Yearly visits to PCP (0, 1-3, > 3) Integrated care clinic vs. nonintegrated care clinic | X | Relationship status (married/living with a partner, never married, divorced, other) Gender (male, female, transgender) |
| Rahangdale (2010) | Cervical Cytology Mammography | Prevalence of at least one pap test/ screening: 78% Prevalence of abnormal pap smears: 33% Prevalence of mammography: 65% Prevalence of abnormal mammography: 0% | EHR abstracted | X | X | Type of provider (primary care physicians, gynecologists) | X | Primary language (English, Spanish) |
| Short (2019) | Cervical cytology Mammography | Prevalence of pap test/ screening in past 2 years: 44% Prevalence of mammography in past two years: 28% | EHR abstracted | Poverty level: Living at or below the poverty level (No, Yes) Homelessness (No, Yes) |
Educational attainment (< High school, High school diploma or GED, > High school) | Insurance coverage (Any private insurance, Public insurance only, Ryan White coverage or uninsured) | X | X |
| Simonsen (2014) | Cervical cytology Mammography Colorectal cancer screening | Cervical cancer screening prevalence: 57% Mammography prevalence: 65% Colorectal cancer screening: 10% | EHR abstracted | Housing stability (Stable, Homeless/transient/ subsidized) | X | Insurance coverage (Private insurance, Medicaid/ Medicare, Primary Care Alliance (Ryan White Part C Program), Other) | X | Immigrant status (US citizen, Other) Primary language (English, Spanish, other) |
Abbreviations: AIN anal intraepithelial neoplasia, CRC colorectal cancer, DARE digital anal rectal examination, EHR electronic health records, FPL federal poverty level, GED General educational development, HMO Health management organization, HRA high resolution anoscopy, HSIL high-grade intraepithelial lesions, HPV human papillomavirus, LDCT low-dose computed tomography, LCS Lung cancer screening, MSM men who have sex with men, MSW men who have sex with women, NP nurse provider, PR Puerto Rico, RWHAP Ryan White HIV/AIDS Program, PSA prostate-specific antigen, PCP primary care physician, PWH People with HIV
X indicates there was no SDOH measure within the column's category included in the study