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.
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.


CONCLUSIONS
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.
Du
Xianglin L
XL
School of Public Health, University of Texas Health Science Center, 1200 Herman Pressler Drive, RAS-E631, Houston, TX 77030, USA. xianglin.L.Du@uth.tmc.edu
Fang
Shenying
S
Coker
Ann L
AL
Sanderson
Maureen
M
Aragaki
Corrine
C
Cormier
Janice N
JN
Xing
Yan
Y
Gor
Beverly J
BJ
Chan
Wenyaw
W
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004522:Educational Status; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D018426:SEER Program; D012923:Social Class; D012959:Socioeconomic Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*