Health Equity and Digital Disparities in Cancer Screening and Cardiovascular Care Across Socioeconomic and Ethnic Groups: A Systematic Review

Abstract

Background: The current disparity in breast screening and cardiac care has been one of the major health concerns in the world. Preventive services, timely diagnosis and evidence-based interventions continue to be dependent on socioeconomic status (SES) and ethnicity. These gaps are significant to comprehend so as to craft interventions that have the potential of contributing to health equity.

Objectives: This is to undertake a systematic review and synthesis of evidence on disparities in cancer screening (breast, colorectal, cervical), and cardiovascular care (hypertension control, lipid management and revascularization) according to socioeconomic and ethnic categories and the strategies that have been demonstrated to reduce these disparities.

Methods: A review of the system was conducted in compliance with PRISMA 2020. Four databases (PubMed, Scopus, Web of Science, and Google Scholar) were searched to identify those articles which were published after January 2010 and until March 2023. The eligible studies were adults (18 years or older) who were stratified by SES and / or ethnicity, and reported the outcomes of screening rates or cardiovascular prevention or therapeutic care. Two independent reviewers screened, extracted and quality-assessed studies, using the NewcastleOttawa Scale of observational designs and Cochrane RoB 2 tool of trials. Random-effects pooling was applied where appropriate and quantitative and qualitative methods of synthesis were utilized.

• Results: Two hundred and eighty-eight studies were eligible with 112,450 patients. Cancer screening: The low-income and minority groups had a 2035% lower uptake of mammography and colorectal screening (RR = 0.72 95% CI 0.660.79). These included barriers of cost, poor health literacy and distrust of healthcare systems. Cardiovascular care: Socioeconomically disadvantaged and ethnic minority populations had reduced blood pressure management (OR = 0.67; 95% CI 0.610.74) and reduced statin-use and revascularization (RR = 0.82; 95% CI 740.91). Patient engagement: There is a high positive correlation between patient engagement and improved outcomes (r = 0.69). The programs were culturally tailored by use of education and orientation, which increased screening and adherence to medication. Confidence and system preparedness: The low trust levels (2.7/5 vs. 3.9/5) in the underprivileged groups were the indicators of structural barriers and discrimination.

Conclusion: Cancer screening and cardiovascular care differences exist in socioeconomic and ethnic groups, which are major and persistent. It has been shown that community-based outreach, culturally competent navigation and policy-level expansion of insurance may be effective solutions to addressing these gaps. Equity measures and intersectional analysis and long term follow up should be employed as the methods of standardizing follow up in future studies when evaluating sustainable impact is required.