Association of Census Tract-Level Socioeconomic Status with Disparities in Prostate Cancer-Specific Survival
Published Date:Jul 22 2011
Source:Cancer Epidemiol Biomarkers Prev. 20(10):2150-2159.
Pubmed Central ID:PMC3189295
Funding:AG023424/AG/NIA NIH HHS/United States
P20 MD001816/MD/NIMHD NIH HHS/United States
P50 CA106743-02S1/CA/NCI NIH HHS/United States
P50CA106743/CA/NCI NIH HHS/United States
P60MD003424/MD/NIMHD NIH HHS/United States
R01 CA116750/CA/NCI NIH HHS/United States
R01CA129140/CA/NCI NIH HHS/United States
R18DP001140/DP/NCCDPHP CDC HHS/United States
Social determinants of prostate cancer survival and their relation to racial/ethnic disparities thereof are poorly understood. We analyzed whether census tract-level socioeconomic status (SES) at diagnosis is a prognostic factor in men with prostate cancer and helps explain racial/ethnic disparities in survival.
We used a retrospective cohort of 833 African-American and white, non-Hispanic men diagnosed with prostate cancer at four Chicago-area medical centers between 1986 and 1990. Tract-level concentrated disadvantage (CD), a multi-dimensional area-based measure of SES, was calculated for each case using 1990 U.S. census data. Its association with prostate cancer-specific survival was measured using Cox proportional hazard models adjusted for case and tumor characteristics, treatment, and healthcare system (private sector vs. Veterans Administration [VA]).
Tract-level CD associated with an increased risk of death from prostate cancer (highest vs. lowest quartile, hazard ratio [HR] = 2.37, p < .0001). However, the association was observed in the private sector and not in the VA (per 1 standard deviation [SD] increase, HR = 1.33, p < .0001 and HR = 0.93, p = .46, respectively). The multivariate HR for African Americans before and after accounting for tract-level CD was 1.30 (p = .0036) and 0.96 (p = .82), respectively.
Census tract-level SES is a social determinant of prostate-specific mortality and helps account for racial/ethnic disparities in survival. An equal-access healthcare system may moderate this association.
This study identifies a potential pathway for minimizing disparities in prostate cancer control. The findings need confirmation in a population-based study.
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