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Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma

Findings from a large community-based cohort

  1. Xianglin L. Du M.D., Ph.D.1,†,*,
  2. Shenying Fang M.D., M.S.1,
  3. Ann L. Coker Ph.D.1,
  4. Maureen Sanderson Ph.D.1,
  5. Corrine Aragaki Ph.D.1,
  6. Janice N. Cormier M.D. MPH2,
  7. Yan Xing M.D., M.S.2,
  8. Beverly J. Gor Ed.D., R.D.3,
  9. Wenyaw Chan Ph.D.1

Article first published online: 13 FEB 2006

DOI: 10.1002/cncr.21732

Issue

Cancer

Cancer

Volume 106, Issue 6, pages 1276–1285, 15 March 2006

Additional Information

How to Cite

Du, X. L., Fang, S., Coker, A. L., Sanderson, M., Aragaki, C., Cormier, J. N., Xing, Y., Gor, B. J. and Chan, W. (2006), Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma. Cancer, 106: 1276–1285. doi: 10.1002/cncr.21732

Author Information

  1. 1

    School of Public Health, University of Texas Health Science Center, Houston, Texas

  2. 2

    Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas

  3. 3

    Center for Research on Minority Health, University of Texas MD Anderson Cancer Center, Houston, Texas

  1. †

    Fax: (713) 500-9264

*University of Texas School of Public Health, 1200 Herman Pressler Dr., RAS-E631, Houston, TX 77030

Publication History

  1. Issue published online: 2 MAR 2006
  2. Article first published online: 13 FEB 2006
  3. Manuscript Accepted: 5 OCT 2005
  4. Manuscript Received: 8 JUL 2005

Funded by

  • National Cancer Institute
  • Center for Medicare and Medicaid Services
  • Information Management Services, Inc.
  • SEER Program tumor registries

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Keywords:

  • prostate carcinoma;
  • race/ethnicity;
  • disparity;
  • socioeconomic status;
  • survival

Abstract

BACKGROUND

Few studies have examined the outcomes for Hispanic men with prostate carcinoma and incorporated socioeconomic factors in association with race/ethnicity in affecting survival, adjusting for factors on cancer stage, grade, comorbidity, and treatment.

METHODS

We studied a population-based cohort of 61,228 men diagnosed with local or regional stage prostate carcinoma at age 65 years or older between 1992 and 1999 in the 11 SEER (Surveillance, Epidemiology, and End Results) areas, identified from the SEER-Medicare linked data with up to 11 years of followup.

RESULTS

Low socioeconomic status was significantly associated with decreasing survival in all men with prostate carcinoma. Those living in the community with the lowest quartile of socioeconomic status were 31% more likely to die than those living in the highest quartile (hazard ratio [HR] of all-cause mortality: 1.31; 95% confidence interval [CI]: 1.25–1.36) after adjustment for patient age, comorbidity, Gleason score, and treatment. The HR remained almost unchanged after controlling for race/ethnicity (HR: 1.32; 95% CI: 1.26–1.38). Compared with Caucasians, the risk of mortality in African American men was marginally significantly higher (HR: 1.06; 95% CI: 1.01–1.11) after controlling for education, and no longer significant after adjusting for poverty, income, or composite socioeconomic variable; the HR was lower for Hispanic men (HR: 0.80; 95% CI: 0.72–0.89) after adjustment for education and other socioeconomic variables.

CONCLUSION

Racial disparity in survival among men with local or regional prostate carcinoma was largely explained by socioeconomic status and other factors. Lower socioeconomic status appeared to be one of the major barriers to achieving comparable outcomes for men with prostate carcinoma. Cancer 2006. © 2006 American Cancer Society.

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