Socioeconomic status, healthcare density, and risk of prostate cancer among African American and Caucasian men in a large prospective study.
OBJECTIVE
The purpose of this study was to separately examine the impact of neighborhood socioeconomic deprivation and availability of healthcare resources on prostate cancer risk among African American and Caucasian men.


METHODS
In the large, prospective NIH-AARP Diet and Health Study, we analyzed baseline (1995-1996) data from adult men, aged 50-71 years. Incident prostate cancer cases (n = 22,523; 1,089 among African Americans) were identified through December 2006. Lifestyle and health risk information was ascertained by questionnaires administered at baseline. Area-level socioeconomic indicators were ascertained by linkage to the US Census and the Area Resource File. Multilevel Cox models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).


RESULTS
A differential effect among African Americans and Caucasians was observed for neighborhood deprivation (p-interaction = 0.04), percent uninsured (p-interaction = 0.02), and urologist density (p-interaction = 0.01). Compared to men living in counties with the highest density of urologists, those with fewer had a substantially increased risk of developing advanced prostate cancer (HR = 2.68, 95 % CI = 1.31, 5.47) among African American.


CONCLUSIONS
Certain socioeconomic indicators were associated with an increased risk of prostate cancer among African American men compared to Caucasians. Minimizing differences in healthcare availability may be a potentially important pathway to minimizing disparities in prostate cancer risk.
Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD 20852, USA. Jacqueline.major@nih.gov
Jacqueline M
JM
Major
M
M
Norman Oliver
Chyke A
CA
Doubeni
Albert R
AR
Hollenbeck
Barry I
BI
Graubard
Rashmi
R
Sinha
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D003695:Delivery of Health Care / Q000208:ethnology* / Q000379:methods / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000208:ethnology*; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*