title: Association of census tract-level socioeconomic status with disparities in prostate cancer-specific survival.
abstract: BACKGROUND
  Social determinants of prostate cancer survival and their relation to racial/ethnic disparities thereof are poorly understood. We analyzed whether census tract-level socioeconomic status (SES) at diagnosis is a prognostic factor in men with prostate cancer and helps explain racial/ethnic disparities in survival.
  
  
  METHODS
  We used a retrospective cohort of 833 African American and white, non-Hispanic men diagnosed with prostate cancer at four Chicago area medical centers between 1986 and 1990. Tract-level concentrated disadvantage (CD), a multidimensional area-based measure of SES, was calculated for each case, using the 1990 U.S. census data. Its association with prostate cancer-specific survival was measured by using Cox proportional hazard models adjusted for case and tumor characteristics, treatment, and health care system [private sector vs. Veterans Health Administration (VA)].
  
  
  RESULTS
  Tract-level CD associated with an increased risk of death from prostate cancer (highest vs. lowest quartile, HR = 2.37, P < 0.0001). However, the association was observed in the private sector and not in the VA (per 1 SD increase, HR = 1.33, P < 0.0001 and HR = 0.93, P = 0.46, respectively). The multivariate HR for African Americans before and after accounting for tract-level CD was 1.30 (P = 0.0036) and 0.96 (P = 0.82), respectively.
  
  
  CONCLUSIONS
  Census tract-level SES is a social determinant of prostate-specific mortality and helps account for racial/ethnic disparities in survival. An equal-access health care system may moderate this association.
  
  
  CONCLUSIONS
  This study identifies a potential pathway for minimizing disparities in prostate cancer control. The findings need confirmation in a population-based study.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL 60637, USA. freem981@uic.edu
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Freeman
authors.forename: Ana C
authors.initials: AC
authors.lastname: Ricardo
authors.forename: Richard T
authors.initials: RT
authors.lastname: Campbell
authors.forename: Richard E
authors.initials: RE
authors.lastname: Barrett
authors.forename: Richard B
authors.initials: RB
authors.lastname: Warnecke
mesh_terms: D001741:Black or African American; D000368:Aged; D019352:Censuses; D002641:Chicago; D015331:Cohort Studies; D005500:Follow-Up Studies; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000208:ethnology / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class; D015996:Survival Rate; D044465:White People