title: Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of California.
abstract: BACKGROUND
  The racial/ethnic disparities in prostate cancer rates are well documented, with the highest incidence and mortality rates observed among African-Americans followed by non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders. Whether socioeconomic status (SES) can account for these differences in risk has been investigated in previous studies, but with conflicting results. Furthermore, previous studies have focused primarily on the differences between African-Americans and non-Hispanic Whites, and little is known for Hispanics and Asian/Pacific Islanders.
  
  
  OBJECTIVE
  To further investigate the relationship between SES and prostate cancer among African-Americans, non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders, we conducted a large population-based cross-sectional study of 98,484 incident prostate cancer cases and 8,997 prostate cancer deaths from California.
  
  
  METHODS
  Data were abstracted from the California Cancer Registry, a population-based surveillance, epidemiology, and end results (SEER) registry. Each prostate cancer case and death was assigned a multidimensional neighborhood-SES index using the 2000 US Census data. SES quintile-specific prostate cancer incidence and mortality rates and rate ratios were estimated using SEER*Stat for each race/ethnicity categorized into 10-year age groups.
  
  
  RESULTS
  For prostate cancer incidence, we observed higher levels of SES to be significantly associated with increased risk of disease [SES Q1 vs. Q5: relative risk (RR) = 1.28; 95% confidence interval (CI): 1.25-1.30]. Among younger men (45-64 years), African-Americans had the highest incidence rates followed by non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders for all SES levels. Yet, among older men (75-84 years) Hispanics, following African-Americans, displayed the second highest incidence rates of prostate cancer. For prostate cancer deaths, higher levels of SES were associated with lower mortality rates of prostate cancer deaths (SES Q1 vs. Q5: RR = 0.88; 95% CI: 0.92-0.94). African-Americans had a twofold to fivefold increased risk of prostate cancer deaths in comparison to non-Hispanic Whites across all levels of SES.
  
  
  CONCLUSIONS
  Our findings suggest that SES alone cannot account for the greater burden of prostate cancer among African-American men. In addition, incidence and mortality rates of prostate cancer display different age and racial/ethnic patterns across gradients of SES.
authors.affiliation: Department of Epidemiology and Biostatistics and Institute for Human Genetics, University of California, San Francisco, San Francisco, CA 94143-0794, USA. chengi@humgen.ucsf.edu
authors.forename: Iona
authors.initials: I
authors.lastname: Cheng
authors.forename: John S
authors.initials: JS
authors.lastname: Witte
authors.forename: Laura A
authors.initials: LA
authors.lastname: McClure
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Shema
authors.forename: Myles G
authors.initials: MG
authors.lastname: Cockburn
authors.forename: Esther M
authors.initials: EM
authors.lastname: John
authors.forename: Christina A
authors.initials: CA
authors.lastname: Clarke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D002277:Carcinoma / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality*; D018864:Cultural Diversity; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011153:Population; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality*; D018426:SEER Program; D012923:Social Class; D015996:Survival Rate