Association of Census Tract-Level Socioeconomic Status with Disparities in Prostate Cancer-Specific Survival

Details

• Alternative Title:
  Cancer Epidemiol Biomarkers Prev
• Personal Author:
  Freeman, Vincent L. ; Ricardo, Ana C. ; Campbell, Richard T. ; Barrett, Richard E. ; Warnecke, Richard B.
• Description:
  Background
  
  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.
  
  Methods
  
  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]).
  
  Results
  
  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.
  
  Conclusion
  
  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.
  
  Impact
  
  This study identifies a potential pathway for minimizing disparities in prostate cancer control. The findings need confirmation in a population-based study.
  
  
• Keywords:
  Aged Black Or African American Censuses Chicago Cohort Studies Follow-Up Studies Healthcare Disparities Health Status Disparities Humans Male Prognosis Prostatic Neoplasms Retrospective Studies Risk Factors Social Class Socioeconomic Status Survival Survival Rate White People

  More +
• Source:
  Cancer Epidemiol Biomarkers Prev. 20(10):2150-2159
• Pubmed ID:
  21784953
• Pubmed Central ID:
  PMC3189295
• Document Type:
  Journal Article
• Funding:
  P60 MD003424/MD/NIMHD NIH HHSUnited States/ ; P50CA106743/CA/NCI NIH HHSUnited States/ ; R18 DP001140/DP/NCCDPHP CDC HHSUnited States/ ; R01 CA116750/CA/NCI NIH HHSUnited States/ ; R01CA129140/CA/NCI NIH HHSUnited States/ ; P20 MD001816/MD/NIMHD NIH HHSUnited States/ ; R18DP001140/DP/NCCDPHP CDC HHSUnited States/ ; R01 CA129140/CA/NCI NIH HHSUnited States/ ; R01 AG023424/AG/NIA NIH HHSUnited States/ ; P50 CA106743/CA/NCI NIH HHSUnited States/ ; P60MD003424/MD/NIMHD NIH HHSUnited States/ ; P50 CA106743-02S1/CA/NCI NIH HHSUnited States/ ; AG023424/AG/NIA NIH HHSUnited States/
• Volume:
  20
• Issue:
  10
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:d4977bf13b8fee1940e9f58754c9013832e5921b2fd200fb8d2b1abcc1c082f1
• Download URL:
  https://stacks.cdc.gov/view/cdc/33254/cdc_33254_DS1.pdf
• File Type:
  [PDF - 360.07 KB ]