title: Individual- and neighborhood-level education influences the effect of obesity on prostate cancer treatment failure after prostatectomy.
abstract: OBJECTIVE
  The relationship between obesity and prostate cancer (CaP) treatment failure is complex and may vary by patient- and neighborhood-level educational attainment. We evaluated whether patient- and neighborhood-level education is associated with the effect of obesity on biochemical recurrence.
  
  
  METHODS
  Seven hundred and forty-six CaP cases were classified into four groups: Concordant Low-Low: less educated cases (<4 years college) living in a less educated neighborhood (below-median proportion of college-educated residents; n = 164); Concordant High-High: highly educated cases (≥ 4 years college) living in a highly educated neighborhood (above-median proportion of college-educated residents; n = 326); Discordant Low-High: less educated cases living in a highly educated neighborhood (n = 69); and Discordant High-Low: highly educated cases living in a less educated neighborhood (n = 187). Cox regression models were used to examine associations between obesity and biochemical (PSA) failure after prostatectomy stratified by the concordant/discordant groups.
  
  
  RESULTS
  The association of obesity with biochemical failure varied significantly by educational concordance/discordance (p = 0.007). Obesity was associated with risk of biochemical failure for less educated cases residing in less educated neighborhoods (HR 3.72, 95% CI 1.30-10.65). The relationship was not significant for other concordant/discordant groups.
  
  
  CONCLUSIONS
  Obesity effects on CaP outcomes vary by multilevel educational discordance/concordance. Strategies to decrease prostate cancer risk of progression may focus on reduction in obesity, particularly for less educated cases residing in less educated neighborhoods.
authors.affiliation: Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA, charnita.zeigler-johnson@jefferson.edu.
authors.forename: Charnita
authors.initials: C
authors.lastname: Zeigler-Johnson
authors.forename: Knashawn H
authors.initials: KH
authors.lastname: Morales
authors.forename: Karen
authors.initials: K
authors.lastname: Glanz
authors.forename: Elaine
authors.initials: E
authors.lastname: Spangler
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mitchell
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Rebbeck
mesh_terms: D000368:Aged; D018450:Disease Progression; D004522:Educational Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000150:complications* / Q000601:surgery*; D012111:Residence Characteristics; D017211:Treatment Failure