title: Impact of Comorbidities on Prostate Cancer Stage at Diagnosis in Florida.
abstract: To examine the association of major types of comorbidity with late-stage prostate cancer, a random sample of 11,083 men diagnosed with prostate cancer during 2002-2007 was taken from the Florida Cancer Data System. Individual-level covariates included demographics, primary insurance payer, and comorbidity following the Elixhauser Index. Socioeconomic variables were extracted from Census 2000 data and merged to the individual level data. Provider-to-case ratio at county level was alsocomputed. Multilevel logistic regression was used to assess associations between these factors and late-stage diagnosis of prostate cancer. Higher odds of late-stage diagnosis was significantly related to presence of comorbidities, being unmarried, current smoker, uninsured, and diagnosed in not-for-profit hospitals. The study reported that the presence of certain comorbidities, specifically 10 out of the 45, was associated with late-stage prostate cancer diagnosis. Eight out of 10 significant comorbid conditions were associated with greater risk of being diagnosed at late-stage prostate cancer. On the other hand, men who had chronic pulmonary disease, and solid tumor without metastasis, were less likely to be diagnosed with late-stage prostate cancer. Late-stage diagnosis was associated with comorbidity, which is often associated with increased health care utilization. The association of comorbidity with late-stage prostate cancer diagnosis suggests that individuals with significant comorbidity should be offered routine screening for prostate cancer rather than focusing only on managing symptomatic health problems.
authors.affiliation: Florida A&M University, Tallahassee, FL, USA hong.xiao@famu.edu.
authors.forename: Hong
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Indiana University-Purdue University Indianapolis, IN, USA.
authors.forename: Fei
authors.initials: F
authors.lastname: Tan
authors.affiliation: BioMedware Inc., Ann Arbor, MI, USA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Goovaerts
authors.affiliation: Florida A&M University, Tallahassee, FL, USA.
authors.forename: Georges
authors.initials: G
authors.lastname: Adunlin
authors.affiliation: Florida A&M University, Tallahassee, FL, USA.
authors.forename: Askal Ayalew
authors.initials: AA
authors.lastname: Ali
authors.affiliation: University of South Florida, Tampa, FL, USA.
authors.forename: Clement K
authors.initials: CK
authors.lastname: Gwede
authors.affiliation: Centers for Disease Control and Prevention Foundation, Atlanta, GA.
authors.forename: Youjie
authors.initials: Y
authors.lastname: Huang
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D057210:Delayed Diagnosis / Q000009:adverse effects* / Q000191:economics; D005431:Florida / Q000453:epidemiology; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics* / Q000208:ethnology; D006801:Humans; D015994:Incidence; D007348:Insurance, Health / Q000145:classification / Q000191:economics; D008019:Life Style; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D055361:Multilevel Analysis; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000208:ethnology / Q000401:mortality; D012042:Registries; D012720:Severity of Illness Index; D064890:Social Determinants of Health / Q000191:economics* / Q000208:ethnology; D044465:White People / Q000706:statistics & numerical data
keywords: comorbidity; health care utilization; health inequality/disparity; health screening; prostate cancer