Uncovering the Roots of Inequity: Social Determinants and Racial Disparities Among Gastrointestinal Cancer Patients

Abstract Introduction Social Determinants of Health (SDoH) profoundly influence cancer outcomes, yet their distribution among racially diverse gastrointestinal (GI) cancer patients remains understudied. This study examines racial differences in SDoH between non-Hispanic White (NHW) and Non-White (including Asian, African American, and Hispanic) patients with gastrointestinal (GI) cancers using data from the All of Us Research Program. Methods A total of 6,620 participants with GI cancer were identified using ICD-10 and SNOMED codes, of whom 1,831 completed the SDoH survey and were included in the analysis. Descriptive statistics summarized SDoH constructs such as social cohesion, support, and neighborhood disorder. Variables were categorized using validated scoring tools or grouped into tertiles. Group comparisons used chi-square, t-tests, or Wilcoxon rank-sum tests. Results Among the 1,831 participants included in the overall cohort, 80.7% (n = 1,478) identified as non-Hispanic White and 13.9% (n = 255) as Non-White, including Black or African American (6.2%), Hispanic or Latino (6.4%), and Asian (1.4%). NHW participants were older (71.0 vs. 64.2 years) and reported greater social cohesion (3.9 vs. 3.6, p < 0.001) and support (3.9 vs. 3.7, p < 0.001). Non-White patients reported higher perceived discrimination (1.7 vs. 1.5, p = 0.016), daily spiritual experience (4.5 vs. 3.7, p < 0.001), neighborhood disorder (2.2 vs. 2.1, p < 0.001), food insecurity (23.6% vs. 5.8%, p < 0.001), and housing issues (41.8% vs. 21.8%, p < 0.001). Delayed care (47.1% vs. 26.8%, p < 0.001) and unaffordability of care (9.9% vs. 3.4%, p < 0.001) were also more common. Conclusion Significant racial disparities in SDoH were observed among GI cancer patients. Non-White individuals faced greater economic hardship, environmental disadvantage, and barriers to healthcare access. Key messages What is known on this topic Racial disparities in gastrointestinal cancer outcomes persist, but the social and structural factors underlying these differences are not routinely captured in oncology research. Many cancer datasets emphasize clinical characteristics while underrepresenting patient-reported social, economic, and neighborhood conditions. Addressing social determinants of health is increasingly recognized as necessary to advance equity in cancer care delivery. What this study adds This study provides a comprehensive, patient-reported assessment of social determinants of health among GI cancer patients in the All of Us Research Program. Non-White patients experience a higher burden of economic instability, neighborhood disadvantage, perceived stress,and barriers to accessing healthcare services. These findings identify concrete social risk domains that can inform equity-focused screening, care navigation, and policy interventions within oncology practice.