Disparities In Social Determinants Research Articles

Comparison between machine learning methods for mortality prediction for sepsis patients with different social determinants

BackgroundSepsis is one of the most life-threatening circumstances for critically ill patients in the United States, while diagnosis of sepsis is challenging as a standardized criteria for sepsis identification is still under development. Disparities in social determinants of sepsis patients can interfere with the risk prediction performances using machine learning.MethodsWe analyzed a cohort of critical care patients from the Medical Information Mart for Intensive Care (MIMIC)-III database. Disparities in social determinants, including race, sex, marital status, insurance types and languages, among patients identified by six available sepsis criteria were revealed by forest plots with 95% confidence intervals. Sepsis patients were then identified by the Sepsis-3 criteria. Sixteen machine learning classifiers were trained to predict in-hospital mortality for sepsis patients on a training set constructed by random selection. The performance was measured by area under the receiver operating characteristic curve (AUC). The performance of the trained model was tested on the entire randomly conducted test set and each sub-population built based on each of the following social determinants: race, sex, marital status, insurance type, and language. The fluctuations in performances were further examined by permutation tests.ResultsWe analyzed a total of 11,791 critical care patients from the MIMIC-III database. Within the population identified by each sepsis identification method, significant differences were observed among sub-populations regarding race, marital status, insurance type, and language. On the 5783 sepsis patients identified by the Sepsis-3 criteria statistically significant performance decreases for mortality prediction were observed when applying the trained machine learning model on Asian and Hispanic patients, as well as the Spanish-speaking patients. With pairwise comparison, we detected performance discrepancies in mortality prediction between Asian and White patients, Asians and patients of other races, as well as English-speaking and Spanish-speaking patients.ConclusionsDisparities in proportions of patients identified by various sepsis criteria were detected among the different social determinant groups. The performances of mortality prediction for sepsis patients can be compromised when applying a universally trained model for each subpopulation. To achieve accurate diagnosis, a versatile diagnostic system for sepsis is needed to overcome the social determinant disparities of patients.

Clinical perspectives and strategies for confronting disparities in social determinants of health for Hispanic bilinguals with aphasia

Disparities in social determinants of health (SDOH) such as socioeconomic status and access to quality healthcare present serious barriers to enrollment in clinical rehabilitation programs for individuals who have experienced a stroke, especially for those who identify with a racial-ethnic minority group. Hispanic bilinguals with aphasia (HBWA) are one marginalized group who face even greater enrollment challenges since post-stroke language impairment and limited English proficiency make it difficult to advocate for one's needs and identify appropriate rehabilitation programs. Given the increasing representation of Hispanic individuals in the U.S. (projected to be 30% of the population in 2050), it is imperative that clinicians counter disparities in stroke care by facilitating access to clinical services for HBWA. However, the Hispanic population remains largely understudied in the stroke and aphasia literature, due in part to reduced opportunities to enroll in large-scale clinical research studies. In this paper we highlight how our team at Boston University has designed and implemented a variety of recruitment practices, assessment modifications, and treatment accommodations to circumvent the known barriers to participation in clinical research experienced by HBWA. Furthermore, we discuss the importance of cultural responsiveness and demonstrate how including principles of sensitivity and humility in clinical trial protocols improves participant enrollment and retention. Although clinical adjustments in this study were developed for use with HBWA, the effectiveness of the procedures suggests they may be useful blueprints for expanding access to research opportunities for various marginalized groups.

The critical need for WASH in emergency preparedness in health settings, the case of COVID-19 pandemic in Kisumu Kenya.

The devastating effects of inadequate basic utilities such as water, sanitation, hygiene, waste management and environmental cleaning (WASH) is underscored by the current global pandemic declared on March 11, 2020. This paper explores the experiences of key informants (n = 15) ie government and non-government organization officials on the impacts of the COVID-19 pandemic in health care facilities (HCFs) and the role of WASH in emergency preparedness in health settings and the communities they serve using Kisumu, Kenya as a case study. The results from interviews with the key informants indicate socioecological challenges shaping access to hygiene services in HCFs and related disparities in social determinants of health such as WASH that serve as barriers to the pandemic response. All participants indicated the healthcare system was ill-prepared for the pandemic. Health care workers experienced such severe psychosocial impacts due to the lack of preparedness that they subsequently embarked on strikes in protest. These situations influenced citizens' perceptions of the COVID-19 pandemic as a hoax and resulted in a surge in other population health indicators (e.g., increased maternal mortality; decreased vaccination rates for other illnesses such as measles). We recommend authentic partnerships among all stakeholders to develop and implement context-driven sustainable solutions that integrate WASH and emergency preparedness in HCFs and the communities they serve across all spatial scales, from the global to the local.

Understanding the Health and Well-being of Canadian Black Children and Youth during the COVID-19 pandemic: A Review

The COVID-19 pandemic has exacerbated health inequities and vulnerabilities in our society, with the Black population being disproportionately affected. As previous pandemics have resulted in an increase in adverse events to children and youth, we reviewed the literature to examine the impact of the COVID-19 pandemic on Black children and youth. We found Black children and youth experience psychosocial stressors related to uncertainties of the future. Differential gender effects related to COVID-19 are also apparent. Physical distancing related to the COVID-19 pandemic which resulted in differential impacts on physical activity levels in children. We also noted, increase levels of isolation may result in undetected child abuse. The review highlights the urgent need for multifaceted interventions that address disparities in social determinants of health and psychosocial needs of Black children and youth in Canada. Future research that addresses the effects of the COVID-19 pandemic on Black children and youth is needed to help create context-specific interventions.

Mortality During Readmission Among Children in United States Children's Hospitals

To identify demographic, clinical, and hospital factors associated with mortality on readmission within 180days following an inpatient hospitalization. We conducted a retrospective cohort study including 33 US children's hospitals in the Pediatric Health Information System from January 2010 to June 2020. Our primary outcome was death during readmission within 180days of an index hospitalization among children aged 0-18years. Illness severity during the index hospitalization was defined according to the All Patient-Refined Diagnosis-Related Group-categorized illness severity (ie, minor, moderate, or major/extreme). We performed multivariable logistic regression analysis to identify factors during the index hospitalization associated with mortality during readmission. Among 2 677 111 children discharged, 337 385 (12.6%) were readmitted within 180days of the index hospitalization and 2913 (0.8%) died during readmission. More than one-quarter (26.2%) of deaths among children who were readmitted and died occurred within 10days after discharge from the index hospitalization. Factors independently associated with mortality during readmission included multiple complex chronic conditions, index admissions lasting >7days, moderate or severe/extreme illness during the index hospitalization, and public insurance. Children whose race was reported as Black had greater odds of mortality during readmission compared with children of other races. Among hospitalized children, several demographic and clinical factors present during index hospitalizations were associated with mortality during readmission. Greater odds of mortality during readmission among children whose race was reported as Black likely reflects disparities in social determinants of health and clinical care. Interventions to reduce mortality during readmission may target high-risk populations in the period immediately following discharge.

Race Differences in Older Incarcerated Persons' Mental Health

<h3>Introduction</h3> Racial/ethnic (R/E) minorities in the US experience blatant health disparities in terms of both chronic medical conditions and mental health. Among persons in mid-to late-life, these disparities are the result of factors including life-long differential access to healthcare, lower income/education, and societal discrimination. Moreover, as a disproportionate number of persons of color are incarcerated, they will be also be over-represented among the growing population of those who are ‘aging in place' in prison. Prior work shows that race differences in chronic illnesses among community-living persons in mid-to late-life are also reflected among incarcerated persons of color. Yet, little is known regarding race differences in mental health among older incarcerated persons. We sought to compare R/E differences in depressive symptoms and suicidal ideation (SI) among older, incarcerated males. <h3>Methods</h3> Subjects were enrolled in the "Aging Inmates' Suicidal Ideation and Depression Study (Aging INSIDE)." Eligible participants were sentenced male inmates age ≥50, incarcerated in 1 of 8 CT prisons, English-speaking, and not expected to be released for at least 36 months so as to target those ‘aging in place' in prison. Recruitment letters were sent to the 1,019 eligible prisoners between November 2017 and January 2019. A total of 224 inmates returned the interest form, provided written consent to participate in face-to-face baseline and 12-month interviews and chart review, and indicated that they were either Non-Hispanic White (40.4%), Non-Hispanic Black (43.6%), or Hispanic (16.0%). This R/E distribution is generally representative of the population of incarcerated males in CT. Of these, 200 (89%) completed the 12-month interviews. Depressive symptoms were assessed using the 9-item Patient Health Questionnaire (PHQ-9). Current Major Depressive Episode was assessed using Module D of the Structured Clinical Interview for DSM V. The Geriatric Suicidal Ideation Scale (GSIS), overall and four subscales, assessed SI severity. Responding Agree or Strongly agree to the statement "I have tried ending my life in the past," (part of the GSIS but not included in instrument scoring) indicated lifetime suicide attempt. We evaluated R/E differences at baseline and tested for changes between baseline and 12-months within and across R/E groups. <h3>Results</h3> There were several R/E differences in demographic characteristics. Average age was significantly higher among White participants (Whites 58.6[7.3], Blacks 54.9[4.8], Hispanics 55.2[4.7]p < 0.001: p values are for three-mean comparison tests). Fewer Hispanics graduated high school (31.4%) compared with Blacks (25.5%) and Whites (13.2%, p = .035). Blacks average age at first incarceration (22.4 years) was younger than Whites (34.6) and Hispanics (27.3) (p < .001), and more Blacks were repeat offenders than Hispanics and Whites, 84% vs. 71.4% and 49.5%, respectively (p < .001). The table presents R/E differences in mental health at baseline. Hispanics had the highest PHQ-9 scores (7.1[6.8] Hispanics, 6.9[6.1] Whites, 4.5[4.9] Blacks, p = .002) and had the highest proportion of those with PHQ-9>10 (clinically significant symptoms), current MDE, and lifetime suicide attempt. Average GSIS scores differed significantly by R/E (67.8[21.2] Whites, 61.2[18.4] Hispanics, and 55.7[15.0] Blacks, p<0.001). Within each R/E group, there were no significant changes in PHQ-9 scores between baseline and follow-up 12 months later. However, significantly fewer Hispanics were experiencing a current MDE at 12 months; 4 who met clinical criteria at baseline did not meet criteria at follow up (McNemar χ² (1)) = 4.00, p = .045. <h3>Conclusions</h3> Despite ‘aging in place' in a similar environment, we found considerable race differences in depression and SI among this sample of older incarcerated persons. These findings support the ‘Black-White mental health paradox' - Blacks' MH was significantly better than Whites' regardless of disparities in social determinants (e.g., age at first incarceration; repeat offenses). Notably, Hispanics' had especially high depressive symptom scores and a high proportion reported lifetime suicide attempts. This R/E group may benefit from culturally-tailored interventions. Moreover, the stability of scores over time within and across R/E groups suggests that the baseline differences are "true" differences. As the population of older incarcerated persons in the US continues to grow, research is needed to determine mechanisms contributing to poor mental health among older incarcerated Hispanics and to determine if aging in prison exacerbates or attenuates the ‘Black-White mental health paradox'. <h3>This research was funded by</h3> This work was supported by the National Institute of Mental Health (Grant Number R01-MH106529 to L.C.B.). Dr. Barry is also supported by the UConn Claude D. Pepper Older Americans Independence Center (NIA P30-AG067988).

Gender and Racial/Ethnic Disparities in Social Determinants of Health and Subjective Cognitive Decline: The Mediating Role of Depression.

Social determinants of health (SDOH) may be associated with subjective cognitive decline (SCD), which is a precursor for Alzheimer's disease. The main aims of the current study were to examine the association between SDOH and SCD; to determine if there is an indirect pathway among SDOH, depression, and SCD; and to examine the related gender and racial/ethnic disparities. Cross-sectional data were obtained from the 2017 Behavioral Risk Factor Surveillance System Survey (N = 6,509; 2,530 men and 3,978 women aged ≥45 years). Path analyses (stratified by gender and race) were used to determine the relationship between a SDOH index, depression, and SCD. After controlling for gender, age, income, education, employment, and other health-related behaviors, SDOH were positively associated with SCD among the overall population, men, and White populations. SDOH were associated with depression, and depression was associated with SCD among men, women, and White and Black populations. After adjustment for confounders, the indirect pathway among SDOH, depression, and SCD was statistically significant for men (β = 0.035, p < 0.001), women (β = 0.040, p < 0.001), White populations (β = 0.034, p < 0.001), and Black populations (β = 0.036, p = 0.026). Gender and racial/ethnic disparities existed in the relationship among SDOH, depression, and SCD. Future research should assess alternative mediational pathways between SDOH and SCD. [Journal of Gerontological Nursing, 48(2), 13-22.].

The Diabetes-Cardiovascular Connection in Women: Understanding the Known Risks, Outcomes, and Implications for Care.

Cardiovascular disease (CVD) complications constitute about 50-70% of mortality in people with diabetes. However, there remains a persistently greater relative increase in CVD morbidity and mortality in women with diabetes than in their male counterparts. This review presents recent evidence for the risks, outcomes, and management implications for women with diabetes. Compared to men, women have higher BMI and more adverse cardiovascular risk profile at time of diabetes diagnosis with greater risk for coronary heart disease, stroke, vascular dementia, and heart failure. Pregnancy-specific risk factors of gestational diabetes and pre-eclampsia are associated with future type 2 diabetes (T2D) and CVD. Women with T2D may experience greater benefits than men from GLP-1 receptor agonists. Women with diabetes are at greater relative risk for CVD complications than men, with poorer outcomes, superimposed on preexisting gender disparities in social determinants of health, lower likelihood of being offered cardioprotective interventions, and enrollment in trials. Further research and the utilization of SGLT-2 inhibitors, GLP-1 receptor agonists, and other CVD prevention strategies will help reduce morbidity and mortality.

A tridimensional view of the Hispanic Health Paradox: Its relationship with faith, the enclave theory, and familism

This paper examines the "Hispanic (American) Health Paradox," the juxtaposition of Hispanics’ longer lifespan than the average American amid numerous inequities regarding social determinants of health. Hispanic Americans endure multiple health disparities with a higher incidence and prevalence of chronic conditions. They also experience multiple psychosocial and physical health challenges, including higher rates of food insecurity, poverty, segregation, discrimination, and limited or no access to medical care. Nevertheless, Hispanics enjoy better physical well-being and lower mortality rates when compared to non-Hispanics in the United States (Ruiz et al., 2021). This project aims to analyze the sources of this group’s biosocial advantages and resilience, allowing them to have a longer lifespan amidst their lower health status and increased risk for chronic conditions. It explores the political and social justice implications of these inequities. It also examines the strategies to close the gap on Latinos' current health care disparities via public policy aspects of federal and state legislature. A narrative review method was utilized to examine the existing literature on this paradoxical effect. Keywords based on Medical Subject Headings (MeSH) used to search resources for relevant studies included: Hispanic health paradox (health paradox, immigrant paradox), ethnic minorities (Latinos, LatinX), health disparities (disproportionate health, health inequities), social justice (healthcare stakeholders, health inequities solutions, inequities recommendations), mental health, physical health, and co-morbidities. A quality assessment of full-text peer-reviewed articles yielded 80 articles to compile this narrative review. The research revealed that, despite glaring disparities in social determinants of health, Hispanic Americans have overall experienced better health outcomes through a culture that emphasizes spirituality, community support, and strong family ties.

Structural Barriers Associated with the Intersection of Traumatic Stress and Gun Violence: A Case Example of New Orleans.

Gun violence drastically increased in urban cities following the ease of shutdown restrictions associated with the Coronavirus Pandemic. The association of gun violence and COVID-19 has highlighted the importance of taking a public health perspective, particularly as it relates to impacts on the Black community. In this article we discuss macro-level factors and community traumas in the city of New Orleans, an area that has had longstanding issues related to gun violence. Community structural issues, traumatic stress from disasters, and recommendations to address disparities in social determinants of health are discussed.

Disparities in Social Determinants of Health Amongst People with Disabilities

ABSTRACT Social determinants of health are conditions, such as physical and social environments, which contribute to health outcomes. People with disabilities face more health inequities than their nondisabled peers, including disparities in social determinants of health. Although research indicates people with disabilities face a number of disparities compared to their nondisabled peers, less research has focused on disparities in social determinants of health among people with disabilities as a group. The aim of this study was to explore disparities in social determinants of health among people with disabilities. To do so, we analysed Personal Outcome Measures® interviews from 1,473 people with disabilities in the United States to examine correlates of social determinants of health. Findings revealed a number of characteristics that were correlated with lower social determinants of health among people with disabilities: gender; race; primary communication method; disability type; impairment severity; residence type; and organisational supports in place. Many of our findings link to larger structural systems and oppressions. Working on an individual scale to provide better services and supports to individual people with disabilities, although important, is not enough. People with disabilities will not have health equity until structural issues, such as racism, sexism, and ableism, are addressed.

The Impact of Disparities in Social Determinants of Health on Hospitalization Rates for Patients with COVID-19 in Michigan (USA).

ImportanceThe COVID-19 pandemic continues to impact the health-care system in the United States and has brought further light on health disparities within it. However, only a few studies have examined hospitalization risk with regard to social determinants of health.ObjectiveWe aimed to identify how health disparities affect hospitalization rates among patients with COVID-19.DesignThis observational study included all individuals diagnosed with COVID-19 from February 25, 2020 to December 31, 2020. Uni- and multivariate analyses were utilized to evaluate associations between demographic data and inpatient versus outpatient status for patients with COVID-19.SettingMulticenter (8 hospitals), largest size health system in Southeast Michigan, a region highly impacted by the pandemic.ParticipantsAll outpatients and inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab were included. Exclusion criteria included missing demographic data or status as a non-permanent Michigan resident.ExposurePatients who met inclusion and exclusion criteria were divided in 2 groups: outpatients and inpatients.Main Outcome and MeasuresWe described the comparative demographics and known disparities associated with hospitalization status.ResultsOf 30,292 individuals who tested positive for SARS-CoV-2, 34.01% were admitted to the hospital. White or Caucasian race was most prevalent (57.49%), and 23.35% were African-American. The most common ethnicity was non-Hispanic or Latino (70.48%). English was the primary language for the majority of patients (91.60%). Private insurance holders made up 71.11% of the sample. Within the hospitalized patients, lower socioeconomic status, African-American race and Hispanic and Latino ethnicity, non-English speaking status, and Medicare and Medicaid were more likely to be admitted to the hospital.Conclusions and RelevanceSeveral health disparities were associated with greater rates of hospitalization due to COVID-19. Addressing these inequalities from an individual to system level may improve health-care outcomes for those with health disparities and COVID-19.

Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis

IntroductionEarly literature on the COVID-19 pandemic indicated striking ethnic inequalities in SARS-CoV-2-related outcomes. This systematic review and meta-analysis aimed to describe the presence and magnitude of associations between ethnic groups...

Moving toward health equity: A journey

Moving toward health equity: A journey

Facilitating the inclusion of adults with intellectual disability as direct respondents in research: Strategies for fostering trust, respect, accessibility and engagement.

Adults with intellectual disability experience disparities in social determinants of health and health outcomes. While new knowledge can advance health equity, adults with intellectual disability are frequently excluded from being direct respondents in research. Their inclusion requires addressing scientific and ethical challenges that contribute to their exclusion. We describe our multi-phased process, inclusive of community-engagement, to develop a self-report survey for adults with intellectual disability and share findings from an institutional ethnography conducted to identify strategies for facilitating inclusion. We also assessed indicators of the quality of these strategies. We identified building trust, showing respect, designing in accessibility, maximising flexibility and allowing individualised accommodations as strategies that foster inclusion. Multiple indicators validate the effectiveness of these strategies. Researchers can promote first-person decision-making and direct research participation by focusing on promoting accessibility, trust, respect and engagement.

A Cross-Sectional Analysis of Factors Associated with Appointment Completion and Visit Modality during Virtual Urology Visits.

The necessary transition to telehealth during COVID-19 generated new challenges for providers and patients, with the opportunity to exacerbate or mitigate standing care inequities. To better understand virtual medicine care delivery in urology, we sought to identify factors associated with appointment completion and use of telephone or video visits. We performed a retrospective, single-institutional cross-sectional analysis of all remote patient appointments from March 17, 2020-August 31, 2020. The primary outcome was appointment completion rate. Patients were determined to have not completed an appointment if they canceled, left before being seen or were a "no show." Secondary analysis evaluated factors associated with scheduling video vs telephone appointment. Various patient and appointment-specific factors were analyzed. Chi-squared tests and univariate logistic regression were used for analysis accordingly. Of 3,769 appointments, 2,996 (79.5%) were completed while 773 (20.5%) were not, with 1,544 (41.0%) completed over telephone while 2,225 (59.0%) used video. Race, age, income, insurance, location, division and appointment length showed statistical significance (p <0.05) for appointment completion and visit modality. Females were more likely to use video (62.7% vs 58.0%, p=0.01). Patients were more likely to complete afternoon visits (81.1% vs 78.3%, p=0.04), visits with physicians (81.2% vs 75.4%, p <0.01) and phone calls (83.3% vs 76.9%, p <0.01). Multiple factors were associated with both appointment completion rate and use of telephone or video. These factors may reflect disparities in social determinants of health and select patients may benefit from additional coordination of care to prevent missed appointments and deconstruct inequities.

Comparing the health and welfare of refugees and non-refugees at the outset of the COVID-19 pandemic: the results of a community needs assessment.

Refugees are a vulnerable population who experience significant health disparities. They may also be at disproportionately high risk of adverse outcomes due to the COVID-19 pandemic. This paper presents the results of a community needs assessment to investigate the impact of the pandemic on health and welfare in a refugee relocation community in the United States. A multilingual data collection team made up of refugees surveyed 179 participants (128 refugees vs. 51 non-refugees). Only 55.9% of refugee respondents said they would be able to provide enough food for their family this week, compared with 84.0% of non-refugees (p < 0.01), and this difference was even greater for food next week (29.4% vs. 76.0%, p < 0.01). A non-significantly smaller proportion of refugees reported knowing where to go if they were sick (69.1% vs. 81.6%, χ2 = 2.8, p = 0.10), and being able to get the medicine they need (75.0% vs. 87.8%, p = 0.07), while significantly fewer refugees reported feeling safe at home (72.8 vs. 87.8%, χ2 = 4.5, p = 0.04). Overall, refugees fared worse on nearly every measure. These findings should motivate further observational research and inform clinicians about the significant disparities in social determinants of health that refugees may experience during the pandemic.

Perceptions and Experiences of Frontline Urban Indian Organization Healthcare Workers With Infection Prevention and Control During the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) has created significant challenges for outpatient healthcare providers and patients across the United States (U.S.). Forty-one Urban Indian Organizations (UIOs), who provide a wide spectrum of health services for American Indian and Alaska Native (AI/AN) populations and other underinsured and uninsured populations in urban areas across the country, are no exception. The National Council of Urban Indian Health (NCUIH), in collaboration with the U.S. Centers for Disease Control and Prevention (CDC), set out to understand the needs, challenges, and opportunities for improvement in infection prevention and control (IPC) training and systems from the perspective of UIO frontline healthcare workers. As part of the CDC's Project Firstline, NCUIH was chosen as a partner in a national collaborative. The first task was to conduct listening sessions with frontline UIO staff to learn more about IPC practices in the context of the COVID-19 pandemic. Thirty staff from 16 UIOs, representing full ambulatory, limited ambulatory, outreach and referral, and outpatient and residential treatment programs participated in virtual video focus groups in July of 2020. Thematic and content analysis protocols guided data analysis and coding. Analysis of findings generated four major themes: staff adaptation in the context of resilience; responsibility and duty to protect patients, families, and coworkers; mental and emotional issues for UIO staff; and IPC challenges in the context of COVID-19. Participants' challenges ranged from lack of access to personal protective equipment (PPE) to the absence of standardized training. Significant disparities in social determinants of health experienced by Native American and non-Native populations served by UIOs create additional challenges to the delivery of and access to care during the pandemic. The diverse array of tribal cultural values and contexts of the people and communities served by UIOs reportedly serve as both facilitators and barriers to care, awareness, and uptake of infectious disease public health practices.

Socioeconomic Factors Contribute to the Higher Risk of COVID-19 in Racial and Ethnic Minorities With Chronic Liver Diseases

Socioeconomic Factors Contribute to the Higher Risk of COVID-19 in Racial and Ethnic Minorities With Chronic Liver Diseases

The relationship between cancer fatalism and education.

Fatalism is defined by feelings of pessimism, hopelessness, and powerlessness regarding cancer outcomes. Early researchers reported associations between race and cancer fatalism. Yet current evidence suggests that social determinants of health are better predictors of cancer fatalism than race. Therefore, the aim of this study was to examine the association between age, race, education, and cancer fatalism. Three hundred ninety (n = 390) women who attended a screening mammogram at the Joanne Knight Breast Health Center at Siteman Cancer Center at Washington University School of Medicine (St. Louis, MO) completed the Powe Fatalism Inventory (PFI), a 15-item self-report instrument used to operationalize cancer fatalism. We used Pearson's correlation, independent samples t-tests, one-way ANOVA with post hoc tests, and linear regression to analyze the relationships between PFI total scores and age, race, and education. There were no differences between the mean PFI scores for Non-Hispanic Whites (1.89, SD 0.55) and African Americans (2.02, SD 0.76, p = 0.092, 95% CI 0.27 to 0.02). We found significant differences between the mean PFI scores across levels of education. Women who attained a high school degree or less (n = 72) reported higher PFI scores (2.24, SD 0.77) than women who attended some college or post-high school vocational training (n = 111; 1.95, SD 0.61) and women with a college or postgraduate degree (n = 206; 1.83, SD 0.57). When PFI score was regressed onto age, race, and education, only education significantly explained fatalism (B = -0.19, p < 0.001). In this study, cancer fatalism did not differ between Non-Hispanic White and African American women attending a screening mammogram. However, lower educational levels were associated with higher cancer fatalism. The previously observed associations between race and cancer fatalism may be explained by racial disparities in social determinants of health, such as education. Importantly, study findings indicate that the people with the greatest need for cancer fatalism interventions are those with lower educational levels.