Interplay of Race, Socioeconomic Status, and Treatment on Survival of Patients With Prostate Cancer

Schwartz, Kendra; Powell, Isaac J.; Underwood, Willie; George, Julie; Yee, Cecilia; Banerjee, Mousumi

doi:10.1016/j.urology.2009.02.058

Cited by 100 publications

(106 citation statements)

References 24 publications

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“…24 Multilevel studies from the US demonstrated the importance of income inequality for mortality. 16,17,25 In contrast, in Nova Scotia in Canada, a country with lower income inequality than the US, neighborhood socioeconomic characteristics were not significantly associated with mortality. 26 In the UK, previous studies have described neighborhood effects on health.…”

Section: Discussionmentioning

confidence: 94%

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Neighborhood deprivation and prostate cancer mortality: a multilevel analysis from Sweden

Sundquist

2011

Prostate Cancer Prostatic Dis

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in patients aged 25-74 years (a total of 73 159 patients). Multilevel logistic regression analyses were performed with individual-level characteristics at the first level and level of neighborhood deprivation at the second level. RESULTS:The age-standardized prostate cancer mortality rate was 1.5 times higher in men living in high-deprivation neighborhoods than in those living in the most affluent neighborhoods. Mortality rates were also associated with certain individual-level characteristics, that is, age, marital status, family income, educational attainment, immigration status, urban/rural status, mobility and comorbidity. For example, there was a strong relationship between prostate cancer mortality and being unmarried, having a low income or educational attainment, and hospitalization for chronic obstructive pulmonary disease. In the full model, the risk of prostate cancer mortality was 25% higher in men living in the most deprived neighborhoods than in those living in the most affluent neighborhoods.CONCLUSIONS: High level of neighborhood deprivation independently predicts prostate cancer mortality. This raises important clinical and public health concerns. Both individual-and neighborhood-level approaches are important in healthcare policies.

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Section: Discussionmentioning

confidence: 94%

“…[10][11][12][13][14] However, only a few studies have documented the effects of neighborhood-level SES on prostate cancer risk. [15][16][17] To the best of our knowledge, no study to date has simultaneously analyzed the effect of neighborhood-level SES on prostate cancer mortality, after adjusting for individual-level characteristics.…”

Section: Introductionmentioning

confidence: 99%

Neighborhood deprivation and prostate cancer mortality: a multilevel analysis from Sweden

Sundquist

2011

Prostate Cancer Prostatic Dis

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Explaining racial differences in prostate cancer mortality

Taksler

Keating

Cutler

2012

Cancer

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BACKGROUND:In the United States, black males have an annual death rate from prostate cancer that is 2.4 times that of white males. The reasons for this are poorly understood. METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare database, 77,038 black and white males aged >65 years were identified with a first primary diagnosis of prostate cancer between 1995 and 2005, as well as 49,769 controls. The racial gap in mortality was decomposed to differential incidence and stage-specific prostate cancer mortality. The importance of various clinical and socioeconomic factors to each of these components was then examined. RESULTS: The estimated mortality gap for prostate cancer-specific mortality was 1320 more cases per 100,000 males among black than white men. This gap was due to higher prostate cancer incidence among black males (76%) and higher stage-specific mortality once diagnosed (24%). Differences in prostate-specific antigen testing, comorbidities, and income explained 29% of the difference in metastatic cancer incidence but none of the racial gap for local/regional incidence. Conditional on diagnosis, tumor characteristics explained 50% of the racial gap, comorbidities an additional 4%, choice of treatment and physician 17%, and socioeconomic factors 15%. Overall, approximately 25% of the racial gap in mortality and 86% of the gap in mortality conditional on diagnosis could be explained. CONCLUSIONS: More frequent prostate-specific antigen testing for black and low-income males could potentially reduce the prostate cancer mortality gap through earlier diagnosis of tumors that otherwise may become metastatic. More aggressive treat-

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“…Black men are at least 1.4 times more likely to be diagnosed with prostate cancer 3 and 2.4 times more likely to die from the disease compared with White men. 4,5 Despite higher incidence and mortality, 6,7 Black men remain significantly less likely to receive definitive treatment 4,8,9 and less likely to undergo radical prostatectomy. 4,8,10,11 The reasons why Black men are less likely to receive definitive treatment and radical prostatectomy are poorly understood and likely multifactorial.…”

Section: Introductionmentioning

confidence: 99%

Racial Differences in Prostate Cancer Treatment: The Role of Socioeconomic Status

et al. 2017

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Objective: This study examines whether socioeconomic status (SES), measured at both the individual and neighborhood levels, is associated with receipt of definitive treatment for localized prostate cancer and whether these associations mediate racial differences in treatment between non-Hispanic White and non-Hispanic Black men. Design: The Philadelphia Area Prostate Cancer Access Study (P2 Access) is a mailed, cross-sectional survey of men sampled from the Pennsylvania Cancer Registry, combined with neighborhood Census data. Setting: Eight counties in southeastern Pennsylvania. Participants: 2,386 men with prostate adenocarcinoma. Main Measures: Receipt of definitive treatment, race, self-reported income, education, employment status, and neighborhood SES. Results: Overall, Black and White men were equally likely to receive definitive treatment. Men living in neighborhoods with higher SES were more likely to receive definitive treatment (OR 1.57, 95%CI 1.01, 2.42). Among men who received definitive treatment, Black men were significantly less likely to receive radical prostatectomy compared with White men (OR .71, 95% CI .52, .98), as were men with some college education compared with those with a high school education or less (OR .66, 95% CI .47, .94). SES does not mediate racial differences in receipt of definitive treatment or the type of definitive treatment received, and associations with income or employment status were not significant. Conclusions: These results stress the importance of examining racial disparities within geographic areas and highlight the unique associations that different measures of SES, particularly neighborhood SES and education, may have with prostate cancer treatment.Ethn Dis. 2017;27(3):201-208; doi:10.18865/ed.27.3.201.

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Interplay of Race, Socioeconomic Status, and Treatment on Survival of Patients With Prostate Cancer

Cited by 100 publications

References 24 publications

Neighborhood deprivation and prostate cancer mortality: a multilevel analysis from Sweden

Neighborhood deprivation and prostate cancer mortality: a multilevel analysis from Sweden

Explaining racial differences in prostate cancer mortality

Racial Differences in Prostate Cancer Treatment: The Role of Socioeconomic Status

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