title: A prospective study of socioeconomic status, prostate cancer screening and incidence among men at high risk for prostate cancer.
abstract: OBJECTIVE
  Higher socioeconomic status (SES) men are at higher risk of prostate cancer (PCa) diagnosis, an association commonly interpreted as a function of higher rates of prostate screening among higher SES men. However, the extent to which screening explains this association has not been well quantified.
  
  
  METHODS
  Within a Detroit area cohort of 6,692 men followed up after a benign prostate procedure, a case-control study was conducted of 494 PCa cases and controls matched on age, race, duration of follow-up, and date of initial benign finding; 2000 Census data were used in a principal component analysis to derive a single factor, labeled the neighborhood SES index (NSESI), representing zip code-level SES.
  
  
  RESULTS
  Among cases, higher SES was associated with a younger age at initial biopsy: -1.48 years (95 % CI, -2.32, -0.64) per unit NSESI. After adjustment for confounders and duration of follow-up, higher SES was associated with more PSA tests and DRE during follow-up; 9 % (95 % CI, 2, 16) and 8 % (95 % CI, 1, 15) more respectively, per unit NSESI. Higher SES was associated with a higher risk of PCa diagnosis during follow-up, multivariable adjusted OR = 1.26 per unit increase in NSESI (95 % CI, 1.04, 1.49). Further adjustment for screening frequency somewhat reduced the association between SES and PCa risk (OR = 1.19 per unit NSESI, 95 % CI, 0.98, 1.44).
  
  
  CONCLUSIONS
  Differences in screening frequency only partially explained the association between higher zip code SES and PCa risk; other health care-related factors should also be considered as explanatory factors.
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY 10032, USA. Agr3@Columbia.edu
authors.forename: Andrew
authors.initials: A
authors.lastname: Rundle
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Neckerman
authors.forename: Daniel
authors.initials: D
authors.lastname: Sheehan
authors.forename: Michelle
authors.initials: M
authors.lastname: Jankowski
authors.forename: Oleksandr N
authors.initials: ON
authors.lastname: Kryvenko
authors.forename: Deliang
authors.initials: D
authors.lastname: Tang
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Rybicki
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D012307:Risk Factors; D012923:Social Class