Association of area deprivation index and race with prostate cancer-specific mortality among Non-Hispanic black and Non-Hispanic white men in a contemporary North American population

Document Type

Conference Proceeding

Publication Date

3-1-2024

Publication Title

Eur Urol

Abstract

Introduction & Objectives: Increasing evidence indicates poor socioeconomic status and geographic residency in underprivileged areas as potential contributors to disparities in cancer outcomes. For this reason, the measurement of area-level social and economic deprivation index (ADI) can be useful as a predictor of a more comprehensive cancer treatment outcomes assessment. We aimed to examine the impact of ADI and race on Prostate Cancer-Specific Mortality (PCSM) among Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) men in a contemporary North American population. Materials & Methods: We utilized our institutional database which was built by interrogating our electronic medical records for all men who got diagnosed whit PCa within Henry Ford Health (HFH), between 1995 and 2019. ADI is a percentile rank of socio-economic disadvantage, calculated using indicators of income level, income disparity, educational level, employment rate, home values and quality of life. All these indicators were weighted to create a deprivation score and patients were categorized by race and for ADI quartiles (based on the available National ADI decile values).The highest quartile (Q4: 75-100) represented individuals with the most disadvantageous socioeconomic status. The main outcome for our study was PCSM. Competing-risk cumulative incidence curves were used to depict PCSM, after stratifying patients into sub-cohorts based on race and ADI quartiles. MVA was used to examine the impact of ADI quartiles on PCSM after adjusting for all available confounders. Results: A total of 13,039 patients were included. Of these, 4,402 (33.8%) were NHB men. Median (IQR) PSA at diagnosis was 6.0 (4.5, 9.5) ng/ml. In the 4th ADI quartile, there were more NHB patients (60.1%) than White patients (39.9%) (p<0.001). The median (IQR) follow-up time was 5.7 (2.3-10.3) years. At 10-year, PCSM in NHW vs NHB patients was statistically different in the 1st ADI quartile (5.2% vs 10.4%, p<0.001), but not in the 2nd, 3rd, and 4th ADI quartile groups (all p > 0.05). On MVA, NHW and NHB patients in the 4th ADI quartile (most disadvantaged area) had a 1.27-fold (95% CI: 1.02-1.58; p=0.030) higher cancer-specific mortality compared to NHW and NHB patients in the 1st ADI quartile, but race was not an independent predictor of cancer-specific mortality (HR:1.05; 95% CI:0.89-1.23; p=0.564). Conclusions: Our study was the first to assess the differential impact of ADI as a predictor of PCSM based on race in a large contemporary North American cohort. Within the first quartile, NHB patients showed higher cancer-specific mortality compared to NHW patients. Interestingly, race itself was not identified as an independent predictor of cancer-specific mortality, underscoring the significant influence of socio-economic factors, particularly in areas with higher deprivation, on prostate cancer outcomes.

Volume

85

First Page

S357

Last Page

S357

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