Effect of Socioeconomic Factors on Long-term Mortality in Men With Clinically Localized Prostate Cancer

Abstract

OBJECTIVES To examine the effect of socioeconomic factors on survival in black and white patients with local or regional prostate cancer. METHODS All cases (n = 2046) of clinically localized prostate cancer diagnosed from 1990 to 2000 at the Henry Ford Health System and the Henry Ford Medical Group, equal access health centers, were included. Data on the stage, grade, age at diagnosis, socioeconomic status, treatment given, comorbidities, and vital statistics were gathered from the Henry Ford Medical Group tumor registry and computerized databases, pathologic reports, patient charts, Surveillance, Epidemiology, and End Results database, and the national death registry. The endpoints were the overall and cancer-specific survival. Survival was calculated using Cox proportional hazards regression models. RESULTS Of the 2046 cases, 1243 were white and 803 were black. Black patients were more likely to have lower incomes, a greater baseline prostate-specific antigen level, and greater comorbidities. They were also more likely to undergo radiotherapy and less likely to undergo radical prostatectomy. Univariate analysis, with white race as the baseline hazard, showed that black patients had significantly increased cancer-specific (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.01–2.13) and overall (HR 1.29, 95% CI 1.09–1.53) mortality. However, adjusting for insurance status and income on multivariate analysis revealed no significant differences in cancer-specific (HR 1.04, 95% CI 0.66–1.64) and overall (HR 0.96, 95% CI 0.78–1.18) survival. CONCLUSIONS In this cohort, socioeconomic factors were sufficient to explain the disparity in survival between white and black patients. Survival differences disappeared after adjusting for income status on multivariate analysis. UROLOGY 73: 624–630, 2009. © 2009 Elsevier Inc.

Explaining racial differences in prostate cancer mortality

“…Prostate cancer incidence for blacks aged !68 was significantly above that for whites (20,745 per 100,000 versus 14,776 per 100,000) ( Table 2). The risk is higher for all stages.…”

“…41 Prior reports have suggested these differences may be due to less frequent PSA screening, 2-4 less aggressive treatment, [8][9][10][11] less advanced treatment facilities, 15 and lower socioeconomic status [20][21][22][23][24][25][26][27] for black versus white men. But the combined evaluation of these different theories has not been known.…”

Comparison of the epidemiologic features and patterns of initial care for prostate cancer between public and private institutions: a survey by the Brazilian Society of Urology

“…Three recent studies (22)(23)(24) two from the United States and one from Brazil found that prostate cancers were more commonly advanced at diagnosis and the prostate cancer mortality was higher among men with lower socioeconomic status than among those with higher socioeconomic status. Therefore, it is possible that differences in patterns of care between public institutions and private institutions in Sao Paulo State are due to a set of factors such as discrepant local screening polices, tumor biological behavior, socioeconomic status and geographic differences, among patients attended at these two types of health-care system (25,26).…”

The Epidemiology of Prostate Cancer Among Multiethnic Men

“…This shows that the probability of a prostate cancer diagnosis among non-Hispanic Black men is twice that of non-Hispanic White men when there is a cancer diagnosis. The overall prevalence of prostate cancer by race in this 10-year sample shows a higher trend among non-Hispanic Black men than non-Hispanic White men, which is consistent with the literature [3,15,16]. Although this trend was consistent with the literature, the magnitude of the difference in prevalence by race seen in the literature was not evident in this pooled sample.…”

“…The factors identified that may contribute to low participation rates in prostate cancer screening include: lack of access to health care, lack of education on prostate cancer and the importance of early detection, and cultural barriers to initiation and maintenance of screening practices [9,10,16,17]. Reduced access to care can be attributed to various factors including poverty [16,18]. Poverty determines where you live, how you pay for care, and how you physically get to and from doctor visits [18].…”