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

Year: 2011
Type: article
Study design: Observational Study
Abstract: 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 multidimensional area-based measure of SES, was calculated for each case, using the 1990 U.S. census data. Its association with prostate cancer-specific survival was measured by using Cox proportional hazard models adjusted for case and tumor characteristics, treatment, and health care system [private sector vs. Veterans Health Administration (VA)]. RESULTS: Tract-level CD associated with an increased risk of death from prostate cancer (highest vs. lowest quartile, HR = 2.37, P < 0.0001). However, the association was observed in the private sector and not in the VA (per 1 SD increase, HR = 1.33, P < 0.0001 and HR = 0.93, P = 0.46, respectively). The multivariate HR for African Americans before and after accounting for tract-level CD was 1.30 (P = 0.0036) and 0.96 (P = 0.82), respectively. CONCLUSIONS: Census tract-level SES is a social determinant of prostate-specific mortality and helps account for racial/ethnic disparities in survival. An equal-access health care 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.
DOI: 10.1158/1055-9965.epi-11-0344
Language: English
Subfield: Health
Open Access status: green
Funders: University of Illinois at Chicago, National Institute on Aging, National Cancer Institute, National Center for Chronic Disease Prevention and Health Promotion, National Institute on Minority Health and Health Disparities, Cancer Center, University of Illinois at Chicago
Awards: G1556378315, UIC Center for Population Health and Health Disparities, Building Capacity for Health Disparities Research, Health Promotion in Minority Childhood Cancer Survivors, Exercise Adhrence Among Older Adults with Osteoarthritis, Center of Excellence in Eliminating Disparities, Adiposity and Outcomes of Clinically Localized Prostate Cancer, G996737918
OpenAlex ID: W2138842466
FWCI: 2.634
Cites: 54
Cited by: 50
Related to: 10