Trends in mortality among Black and White men with prostate cancer in Massachusetts and Pennsylvania: Race and neighborhood socioeconomic position

Abstract

Background Reducing disparities in men with prostate cancer (PCa) that may be caused by racial and socioeconomic differences is a major public health priority. Few reports have studied whether these disparities have changed over time. Methods Men diagnosed with PCa from January 1, 2000 to December 31, 2015 were identified from the Massachusetts and Pennsylvania cancer registries. All‐cause mortality and PCa and cardiovascular cause‐specific mortality were assessed. To estimate neighborhood socioeconomic position (nSEP), a summary score was generated using census tract‐level measures of income, wealth, educational attainment, and racial and income segregation. Participants were grouped by diagnosis year (2000‐2003, 2004‐2007, 2008‐2011, or 2012‐2015), and changing trends in the mortality rate ratio by race and nSEP were estimated using covariate‐adjusted Cox models with follow‐up for up to 10 years, until death, or until censoring on January 1, 2018. Results There were 193,883 patients with PCa and 43,661 deaths over 1,404,131 person‐years of follow‐up. The Black‐White adjusted hazard ratio (aHR) from 2000 to 2003 through 2012 to 2015 was stable for all‐cause mortality (aHR, 1.14 to 0.97; P for heterogeneity = .42), decreased for PCa‐specific mortality (aHR, 1.38 to 0.93; P for heterogeneity = .005), and increased for cardiovascular mortality (aHR, 1.09 to 1.28; P for heterogeneity = .034). The aHR comparing those in the lowest versus the highest nSEP quintile increased significantly for all‐cause mortality (aHR, 1.54 to 1.79; P for heterogeneity = .008), but not for PCa‐specific mortality (aHR, 1.60 to 1.72; P for heterogeneity = .40) or cardiovascular mortality (aHR, 1.72 to 1.89; P for heterogeneity = .085). conclusions Although Black‐White disparities in prostate mortality declined in Massachusetts and Pennsylvania over the study period, nSEP mortality disparity trends were stagnant or increased, warranting further attention. Lay Summary Few reports have examined whether racial and socioeconomic disparities in prostate cancer mortality have widened or narrowed in recent years. Using data from 2 state registries (Massachusetts and Pennsylvania) with differing intensities of government‐mandated health insurance, trends in racial and neighborhood socioeconomic disparities were studied among Black and White men diagnosed from 2000 to 2015. Overall, trends in racial disparities were stagnant for all‐cause mortality, shrank for prostate mortality, and widened for cardiovascular mortality. Disparities associated with neighborhood socioeconomic status either were stagnant or widened across all mortality end points. In general, disparities were more pronounced in Pennsylvania than in Massachusetts.

Trends in Incidence of Metastatic Prostate Cancer in the US

“…If indeed this increased incidence rate of mPCa is associated with reduced PSA screening, it has important implications for overall PCa morbidity and mortality. There is evidence of a recent rise in incidence rates 16 , 31 of higher grade and stage at diagnosis, coincident with USPSTF recommendations. 11 Even in the present study, which provides the most updated data available, we noted rising incidence rates of N1 disease from 2004 to 2018 (119% increase and 81% increase in men aged ≥75 and 45-74, respectively) and T3 or T4 stage from 2013 through 2018 (38% increase and 31% increase in men aged ≥75 and 45-74, respectively) when comparing time periods before and after the USPSTF recommendations.…”

Access to Prostate-Specific Antigen Testing and Mortality Among Men With Prostate Cancer

“…Clinician density was obtained from the Area Health Resource File 2012. Neighborhood covariates were selected based on prior evidence for associations with prostate cancer outcomes . For mortality models, we considered further adjustment by receipt of surgery, receipt of radiotherapy, and stage at diagnosis, but including these covariates did not alter effect estimates.…”

“…Neighborhood covariates were selected based on prior evidence for associations with prostate cancer outcomes. 22 , 25 , 48 , 49 , 50 , 51 For mortality models, we considered further adjustment by receipt of surgery, receipt of radiotherapy, and stage at diagnosis, but including these covariates did not alter effect estimates. Models for prostate cancer–specific mortality were fit with the same sets of covariates using inverse probability weights for competing risks 52 (eMethods in Supplement 1 ).…”

“…To our knowledge, few have incorporated subcounty-level measures of socioeconomic status (SES), segregation, and environmental factors with individual-level case data to evaluate associations of screening with mortality . Examining associations of screening with mortality in a population-based study with more precise geospatial measures of social and built environments may offer more reliable estimates of potential associations of targeted screening with prostate cancer outcomes . In addition, using databases with wide geographic coverage could identify population subgroups of individuals for whom screening could offer greater benefits …”

“… 22 Examining associations of screening with mortality in a population-based study with more precise geospatial measures of social and built environments may offer more reliable estimates of potential associations of targeted screening with prostate cancer outcomes. 23 , 24 , 25 In addition, using databases with wide geographic coverage could identify population subgroups of individuals for whom screening could offer greater benefits. 26 …”