Racial and ethnic differences in advanced-stage prostate cancer: the Prostate Cancer Outcomes Study.
BACKGROUND
African-Americans have twice the risk of non-Hispanic whites for presenting with advanced-stage prostate cancer. To investigate the reasons for this difference, we evaluated the association between race/ethnicity and advanced-stage prostate cancer, adjusting for demographic, socioeconomic, clinical, and pathologic factors.


METHODS
A population-based cohort of 3173 men diagnosed with prostate cancer between October 1, 1994, and October 31, 1995, was analyzed. Medical record abstracts and self-administered survey questionnaires were used to obtain information regarding race/ethnicity, age, marital status, insurance status, educational level, household income, employment status, comorbidity, urinary function, prostate-specific antigen level, tumor grade, and clinical stage. The odds ratio (OR) for advanced-stage prostate cancer was estimated with weighted logistic regression analysis. All P: values were two-sided.


RESULTS
Clinically advanced-stage prostate cancers were detected more frequently in African-Americans (12.3%) and Hispanics (10.5%) than in non-Hispanic whites (6.3%). Socioeconomic, clinical, and pathologic factors each accounted for about 15% of the increased relative risk. After adjusting for all covariates, the risk remained statistically significantly increased for African-Americans (OR = 2.26; 95% confidence interval [CI] = 1.43 to 3.58) but not for Hispanics (OR = 1.23; 95% CI = 0.73 to 2.08).


CONCLUSIONS
Traditional socioeconomic, clinical, and pathologic factors accounted for the increased relative risk for presenting with advanced-stage prostate cancer in Hispanic but not in African-American men.
Medicine Service, Department of Veterans Affairs Medical Center, Albuquerque, NM 87108, USA. rhoffman@unm.edu
R M
RM
Hoffman
F D
FD
Gilliland
J W
JW
Eley
L C
LC
Harlan
R A
RA
Stephenson
J L
JL
Stanford
P C
PC
Albertson
A S
AS
Hamilton
W C
WC
Hunt
A L
AL
Potosky
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000704:Analysis of Variance; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*