title: Effect of socioeconomic factors on long-term mortality in men with clinically localized prostate cancer.
abstract: OBJECTIVE
  To examine the effect of socioeconomic factors on survival in black and white patients with local or regional prostate cancer.
  
  
  METHODS
  All cases (n = 2046) of clinically localized prostate cancer diagnosed from 1990 to 2000 at the Henry Ford Health System and the Henry Ford Medical Group, equal access health centers, were included. Data on the stage, grade, age at diagnosis, socioeconomic status, treatment given, comorbidities, and vital statistics were gathered from the Henry Ford Medical Group tumor registry and computerized databases, pathologic reports, patient charts, Surveillance, Epidemiology, and End Results database, and the national death registry. The endpoints were the overall and cancer-specific survival. Survival was calculated using Cox proportional hazards regression models.
  
  
  RESULTS
  Of the 2046 cases, 1243 were white and 803 were black. Black patients were more likely to have lower incomes, a greater baseline prostate-specific antigen level, and greater comorbidities. They were also more likely to undergo radiotherapy and less likely to undergo radical prostatectomy. Univariate analysis, with white race as the baseline hazard, showed that black patients had significantly increased cancer-specific (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.01-2.13) and overall (HR 1.29, 95% CI 1.09-1.53) mortality. However, adjusting for insurance status and income on multivariate analysis revealed no significant differences in cancer-specific (HR 1.04, 95% CI 0.66-1.64) and overall (HR 0.96, 95% CI 0.78-1.18) survival.
  
  
  CONCLUSIONS
  In this cohort, socioeconomic factors were sufficient to explain the disparity in survival between white and black patients. Survival differences disappeared after adjusting for income status on multivariate analysis.
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York, New York, USA. akt2002@med.cornell.edu
authors.forename: Ashutosh K
authors.initials: AK
authors.lastname: Tewari
authors.forename: Heather Taffet
authors.initials: HT
authors.lastname: Gold
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Demers
authors.forename: Christine Cole
authors.initials: CC
authors.lastname: Johnson
authors.forename: Rajiv
authors.initials: R
authors.lastname: Yadav
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
authors.forename: Marianne Ulcickas
authors.initials: MU
authors.lastname: Yood
authors.forename: Terri S
authors.initials: TS
authors.lastname: Field
authors.forename: George
authors.initials: G
authors.lastname: Divine
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000401:mortality*; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors; D044465:White People