Use of empiric methods to inform prostate cancer health disparities: Comparison of neighborhood‐wide association study “hits” in black and white men

Abstract

BACKGROUND: Black men are more likely to die of prostate cancer (PCa) compared with white men. Factors ranging from genetics to neighborhood environment contribute to these disparities. However, unlike genetics, agnostic investigations that identify candidate variables from large-scale data, and that allow for empiric investigations into differential associations between neighborhood and PCa by race/ethnicity, to the authors' knowledge have not been well explored. Thus, herein, the authors built on their previously developed, empiric neighborhood-wide association study (NWAS) in white men and conducted a NWAS in black men to determine whether findings differed by race. METHODS: Pennsylvania Cancer Registry data were linked to US Census data. For the NWAS in non-Hispanic black men, the authors evaluated the association between 14,663 neighborhood census variables and advanced PCa (11 high-stage and/or high-grade cases and 8632 low-stage and/or low-grade cases), adjusting for age, diagnosis year, spatial correlation, and multiple testing. Odds ratios and 95% credible intervals were reported. Replication of NWAS findings across black and white races was assessed using Bayesian mixed effects models. RESULTS: Five variables related to housing (3 variables), education (1 variable), and employment and/or transportation (1 variable) were found to be significantly associated with advanced PCa in black men compared with 17 socioeconomic variables (mostly related to poverty and/or income) in white men. The top hit in black men was related to crowding in renter-occupied housing (odds ratio, 1.10; 95% credible interval, 1.001-1.12). Nine of 22 NWAS hits (4 of 5 hits in black men) were replicated across racial/ethnic groups. CONCLUSIONS: Different neighborhood variables, or "candidates," were identified across race-specific NWASs. These findings and empiric approaches warrant additional study and may inform PCa racial disparities, particularly future gene-environment studies aimed at identifying patients and/or communities at risk of advanced PCa.

The effect of neighborhood social environment on prostate cancer development in black and white men at high risk for prostate cancer

“…More specifically, both high and low nSES have been reported to have associations with poor PCa outcomes [22,39,56,67,68]. Low SES is often associated with increased PCa stage or grade and increased mortality [22,39,56,69,70]; whereas studies of PCa incidence have found associations with higher SES, partially attributed to increases in PCa screening in men from higher socioeconomic groups [67,68]. Similarly, in this study, we also found significant associations between time to PCa diagnosis and low nSES variables.…”

“…In Black men with a PCa family history, one nSES variable related to housing and homeownership (i.e., owning a home with greater than 3 bedrooms) was associated with shorter time to diagnosis of PCa. In prior literature, housing factors, particularly renting a home and overcrowding (i.e., having more than one occupant per room), both of which often correlate with lower SES and unequal housing policies, have been shown to contribute to disparities in the Black community [56,68,73,74]. Thus, our finding that housing related to homeownership was associated with a poor PCa outcome was surprising.…”

“…Prior PCa studies have found associations with nSES extremes (measured in terms of education, employment, and poverty variables [58,67]). More specifically, both high and low nSES have been reported to have associations with poor PCa outcomes [22,39,56,67,68]. Low SES is often associated with increased PCa stage or grade and increased mortality [22,39,56,69,70]; whereas studies of PCa incidence have found associations with higher SES, partially attributed to increases in PCa screening in men from higher socioeconomic groups [67,68].…”

“…Additionally, a limitation of prior studies is the use of a nSES composite score that might include variables that are not relevant for specific race/ethnic groups [68]. This is one of the reasons we evaluated each nSES variable separately [56]. Our study population contained more Black men and men with a PCa family history, tended to be younger, and varied geographically (our patients were from PA compared to CA and Detroit) [67,68], which could also influence findings.…”

“…While a handful of neighborhood variables were identified in the association study, 3 of 4 significant nSES variables from race-stratified models came from our previous empiric NWAS studies [39,56]. NWAS variables tend to be more specific (i.e., gender/age/specific income range) and represent more than one domain in a single variable compared to traditional, single domain variables (i.e., % unemployment).…”