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Boyle J, Yau J, Slade JL, Butts DA, Zhang Y, Legesse TB, Cellini A, Clark K, Park JY, Wimbush J, Ambulos N, Yin J, Hussain A, Onukwugha E, Knott CL, Wheeler DC, Barry KH. Neighborhood Disadvantage and Prostate Tumor RNA Expression of Stress-Related Genes. JAMA Netw Open 2024; 7:e2421903. [PMID: 38995644 PMCID: PMC11245728 DOI: 10.1001/jamanetworkopen.2024.21903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/09/2024] [Indexed: 07/13/2024] Open
Abstract
Importance African American men experience greater prostate cancer incidence and mortality than White men. Growing literature supports associations of neighborhood disadvantage, which disproportionately affects African American men, with aggressive prostate cancer; chronic stress and downstream biological impacts (eg, increased inflammation) may contribute to these associations. Objective To examine whether several neighborhood disadvantage metrics are associated with prostate tumor RNA expression of stress-related genes. Design, Setting, and Participants This cross-sectional study leveraged prostate tumor transcriptomic data for African American and White men with prostate cancer who received radical prostatectomy at the University of Maryland Medical Center between August 1992 and January 2021. Data were analyzed from May 2023 to April 2024. Exposures Using addresses at diagnosis, 2 neighborhood deprivation metrics (Area Deprivation Index [ADI] and validated bayesian Neighborhood Deprivation Index) as well as the Racial Isolation Index (RI) and historical redlining were applied to participants' addresses. Self-reported race was determined using electronic medical records. Main Outcomes and Measures A total of 105 stress-related genes were evaluated with each neighborhood metric using linear regression, adjusting for race, age, and year of surgery. Genes in the Conserved Transcriptional Response to Adversity (CTRA) and stress-related signaling genes were included. Results A total of 218 men (168 [77%] African American, 50 [23%] White) with a median (IQR) age of 58 (53-63) years were included. African American participants experienced greater neighborhood disadvantage than White participants (median [IQR] ADI, 115 [100-130] vs 92 [83-104]; median [IQR] RI, 0.68 [0.34-0.87] vs 0.11 [0.06-0.14]). ADI was positively associated with expression for 11 genes; HTR6 (serotonin pathway) remained significant after multiple-comparison adjustment (β = 0.003; SE, 0.001; P < .001; Benjamini-Hochberg q value = .01). Several genes, including HTR6, were associated with multiple metrics. We observed higher expression of 5 proinflammatory genes in the CTRA with greater neighborhood disadvantage (eg, CXCL8 and ADI, β = 0.008; SE, 0.003; P = .01; q value = .21). Conclusions and Relevance In this cross-sectional study, the expression of several stress-related genes in prostate tumors was higher among men residing in disadvantaged neighborhoods. This study is one of the first to suggest associations of neighborhood disadvantage with prostate tumor RNA expression. Additional research is needed in larger studies to replicate findings and further investigate interrelationships of neighborhood factors, tumor biology, and aggressive prostate cancer to inform interventions to reduce disparities.
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Affiliation(s)
- Joseph Boyle
- Department of Biostatistics, Virginia Commonwealth University, Richmond
- Massey Comprehensive Cancer Center, Richmond, Virginia
| | - Jessica Yau
- Department of Cellular and Molecular Biomedical Science, University of Maryland School of Medicine, Baltimore
| | - Jimmie L. Slade
- Maryland Community Health Engagement Partnership, Upper Marlboro
| | | | - Yuji Zhang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
| | - Teklu B. Legesse
- Department of Pathology, University of Maryland School of Medicine, Baltimore
| | - Ashley Cellini
- Pathology Biorepository Shared Service, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
| | - Kimberly Clark
- Pathology Biorepository Shared Service, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
| | - Jong Y. Park
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Jessica Wimbush
- University of Maryland Greenebaum Comprehensive Cancer Center Tumor Registry, Baltimore
| | - Nicholas Ambulos
- Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore
| | - Jing Yin
- Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore
| | - Arif Hussain
- Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
- Department of Medicine, University of Maryland School of Medicine, Baltimore
- Baltimore Veterans Administration Medical Center, Baltimore, Maryland
| | - Eberechukwu Onukwugha
- Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore
| | - Cheryl L. Knott
- Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
- Department of Behavioral and Community Health, University of Maryland, College Park, College Park
| | - David C. Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond
- Massey Comprehensive Cancer Center, Richmond, Virginia
| | - Kathryn Hughes Barry
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
- Program in Oncology, University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore
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Gong J, Kim DM, Freeman MR, Kim H, Ellis L, Smith B, Theodorescu D, Posadas E, Figlin R, Bhowmick N, Freedland SJ. Genetic and biological drivers of prostate cancer disparities in Black men. Nat Rev Urol 2024; 21:274-289. [PMID: 37964070 DOI: 10.1038/s41585-023-00828-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
Black men with prostate cancer have historically had worse outcomes than white men with prostate cancer. The causes of this disparity in outcomes are multi-factorial, but a potential basis is that prostate cancers in Black men are biologically distinct from prostate cancers in white men. Evidence suggests that genetic and ancestral factors, molecular pathways involving androgen and non-androgen receptor signalling, inflammation, epigenetics, the tumour microenvironment and tumour metabolism are contributing factors to the racial disparities observed. Key genetic and molecular pathways linked to prostate cancer risk and aggressiveness have potential clinical relevance. Describing biological drivers of prostate cancer disparities could inform efforts to improve outcomes for Black men with prostate cancer.
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Affiliation(s)
- Jun Gong
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Daniel M Kim
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael R Freeman
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hyung Kim
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Leigh Ellis
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bethany Smith
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dan Theodorescu
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Edwin Posadas
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert Figlin
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Neil Bhowmick
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen J Freedland
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
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Du XL, Gao D, Li Z. Incidence trends in prostate cancer among men in the United States from 2000 to 2020 by race and ethnicity, age and tumor stage. Front Oncol 2023; 13:1292577. [PMID: 38098506 PMCID: PMC10720073 DOI: 10.3389/fonc.2023.1292577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
Purpose To explore whether prostate cancer incidence trends from 2000 to 2020 in the United States differed by race and ethnicity, age and tumor stage; to explore racial differences in prostate cancer incidence change due to the impact of COVID-19 pandemic lockdown in 2020; and to determine if there is any high-risk population that can be targeted for prevention. Methods We identified 1,098,349 men who were diagnosed with incident prostate cancer at age ≥20 in 2000-2020 in 17 registries of the Surveillance, Epidemiology, and End Results (SEER) program in the United States; of whom, 778,437 were non-Hispanic whites, 155,111 non-Hispanic blacks, 4,200 American Indians and Alaska Natives (AIAN), 55,267 non-Hispanic Asians/Pacific Islanders, and 105,334 Hispanics. Results Age-adjusted incidence rate of prostate cancer was the highest in blacks (302.6 cases per 100,000 men), followed by whites (186.6), Hispanics (153.2), AIAN (108.5), and Asians (104.9). Age-adjusted prostate cancer incidence rates dramatically decreased from 2000 to 2013 for all ethnic men. However, age-adjusted prostate cancer incidence rates increased from 2014 to 2020, in which the increasing incidence trend looked sharper in blacks and whites, flatter in Asians, and leveled in AIAN and Hispanics. Among men with local or regional stages across all years, prostate cancer incidence rate was significantly higher in blacks, but significantly lower in Hispanics, AIAN, and Asians as compared to whites. Among men in 2007-2013, the risk of distant stage prostate cancer was statistically significantly elevated in blacks (rate-ratio: 2.22, 95% CI: 2.06-2.38) and Hispanics (1.16, 1.06-1.25), not significantly different in AIAN (1.30, 0.92-1.76), but still significantly lower in Asians (0.73, 0.66-0.82) as compared to whites. There was a drop of prostate cancer incidence from 2019 to 2020 likely due to the impact of COVID-19 pandemic lockdown on the access to medical care in 2020. Overall prostate cancer incidence rate decreased by 40.4 cases per 100,000 population from 277.4 in 2019 to 237.0 in 2020 for blacks, 20.9 from 164.2 to 143.3 for whites, 16.8 from 124.8 to 108.0 for Hispanics, 14.9 from 101.7 to 86.8 for AIAN, and 12.6 from 88.4 to 75.8 for Asians. Conclusion The decreasing trend of prostate cancer incidence from 2000 to 2013 was statistically significant for all ethnic men. There was an increasing prostate cancer incidence from 2014 to 2020. Age-adjusted incidence rate of prostate cancer was the highest in blacks, followed by whites, Hispanics, AIAN, and Asians, regardless of age groups, tumor stages, and time periods. There will also be a need to monitor and investigate the prostate cancer incidence trend during and after COVID-19 pandemic season.
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Affiliation(s)
- Xianglin L. Du
- Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
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Bai J, Pugh SL, Eldridge R, Yeager KA, Zhang Q, Lee WR, Shah AB, Dayes IS, D'Souza DP, Michalski JM, Efstathiou JA, Longo JM, Pisansky TM, Maier JM, Faria SL, Desai AB, Seaward SA, Sandler HM, Cooley ME, Bruner DW. Neighborhood Deprivation and Rurality Associated With Patient-Reported Outcomes and Survival in Men With Prostate Cancer in NRG Oncology RTOG 0415. Int J Radiat Oncol Biol Phys 2023; 116:39-49. [PMID: 36736921 PMCID: PMC10106367 DOI: 10.1016/j.ijrobp.2023.01.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Rurality and neighborhood deprivation can contribute to poor patient-reported outcomes, which have not been systematically evaluated in patients with specific cancers in national trials. Our objective was to examine the effect of rurality and neighborhood socioeconomic and environmental deprivation on patient-reported outcomes and survival in men with prostate cancer in NRG Oncology RTOG 0415. METHODS AND MATERIALS Data from men with prostate cancer in trial NRG Oncology RTOG 0415 were analyzed; 1,092 men were randomized to receive conventional radiation therapy or hypofractionated radiation therapy. Rurality was categorized as urban or rural. Neighborhood deprivation was assessed using the area deprivation index and air pollution indicators (nitrogen dioxide and particulate matter with a diameter less than 2.5 micrometers) via patient ZIP codes. Expanded Prostate Cancer Index Composite measured cancer-specific quality of life. The Hopkins symptom checklist measured anxiety and depression. EuroQoL-5 Dimension assessed general health. RESULTS We analyzed 751 patients in trial NRG Oncology RTOG 0415. At baseline, patients from the most deprived neighborhoods had worse bowel (P = .011), worse sexual (P = .042), and worse hormonal (P = .015) scores; patients from the most deprived areas had worse self-care (P = .04) and more pain (P = .047); and patients from rural areas had worse urinary (P = .03) and sexual (P = .003) scores versus patients from urban areas. Longitudinal analyses showed that the 25% most deprived areas (P = .004) and rural areas (P = .002) were associated with worse EuroQoL-5 Dimension visual analog scale score. Patients from urban areas (hazard ratio, 1.81; P = .033) and the 75% less-deprived neighborhoods (hazard ratio, 0.68; P = .053) showed relative decrease in risk of recurrence or death (disease-free survival). CONCLUSIONS Patients with prostate cancer from the most deprived neighborhoods and rural areas had low quality of life at baseline, poor general health longitudinally, and worse disease-free survival. Interventions should screen populations from deprived neighborhoods and rural areas to improve patient access to supportive care services.
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Affiliation(s)
- Jinbing Bai
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
| | - Stephanie L Pugh
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Ronald Eldridge
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Katherine A Yeager
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
| | - Qi Zhang
- Department of Geography, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - W Robert Lee
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Amit B Shah
- WellSpan York Cancer Center, York, Pennsylvania
| | - Ian S Dayes
- McMaster University, Juravinski Cancer Center, Hamilton Health Science, Hamilton, Ontario, Canada
| | - David P D'Souza
- School of Medicine & Dentistry, University of Western Ontario Schulich, London, Ontario, Canada
| | | | | | - John M Longo
- Zablocki VAMC and the Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Jordan M Maier
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Sergio L Faria
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | | | | | | | - Mary E Cooley
- Dana-Farber/Harvard Cancer Center, Boston, Massachusetts
| | - Deborah W Bruner
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia
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Pichardo MS, Minas TZ, Pichardo CM, Bailey-Whyte M, Tang W, Dorsey TH, Wooten W, Ryan BM, Loffredo CA, Ambs S. Association of Neighborhood Deprivation With Prostate Cancer and Immune Markers in African American and European American Men. JAMA Netw Open 2023; 6:e2251745. [PMID: 36662526 PMCID: PMC9860532 DOI: 10.1001/jamanetworkopen.2022.51745] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/28/2022] [Indexed: 01/21/2023] Open
Abstract
Importance Neighborhood variables may be factors in the excessive burden of prostate cancer among African American men. Objective To examine associations between neighborhood deprivation, circulating immune-oncology markers, and prostate cancer among African American and European American men. Design, Setting, and Participants A case-control study was conducted between January 1, 2005, and January 1, 2016. Participants included men with prostate cancer and age- and race-frequency-matched population controls. Participants were recruited at the Baltimore Veterans Affairs Medical Center and University of Maryland Medical Center; controls were obtained through the Maryland Motor Vehicle Administration database. National Death Index follow-up was performed through December 31, 2020, and data analysis was conducted from February 1, 2022, through October 31, 2022. Exposures 2000 Census-tract Neighborhood Deprivation Index as a standardized score. Main Outcomes and Measures Primary outcomes included prostate cancer, all-cause mortality, and disease-specific mortality. Secondary outcomes included the National Comprehensive Cancer Network risk score and serum proteomes for 82 immune-oncology markers with pathway annotation. Results Participants included men with prostate cancer (n = 769: 405 African American, 364 European American men) and age- and race-frequency-matched population controls (n = 1023: 479 African American, 544 European American men). The median survival follow-up was 9.70 years (IQR, 5.77 years), with 219 deaths. Among 884 African American men, mean (SD) age at recruitment was 63.8 (7.6) years; mean (SD) age at recruitment among 908 European American men was 66.4 (8.1) years. In the multivariable logistic regression analysis with individual socioeconomic status adjustment, neighborhood deprivation was associated with 55% increased odds of prostate cancer among African American men (odds ratio [OR], 1.55; 95% CI, 1.33-1.81), but was not associated with the disease among European American men. Residing in the most-deprived vs least-deprived neighborhoods corresponded to 88% higher disease odds (OR, 1.88; 95% CI, 1.30-2.75) among all men and an approximate 3-fold increase among African American men (OR, 3.58; 95% CI, 1.72-7.45), but no association was noted among European American men. In Cox proportional hazard regression analyses, socioeconomic status-adjusted neighborhood deprivation was associated with an increased all-cause mortality only among African American men (hazard ratio [HR], 1.28; 95% CI, 1.08-1.53), whereas it was associated with metastatic disease and a 50% increased hazard of a prostate cancer-specific death among all men (HR, 1.50; 95% CI, 1.07-2.09). In analyses restricted to controls, neighborhood deprivation was associated with increased activity scores of serum proteome-defined chemotaxis, inflammation, and tumor immunity suppression. Conclusions and Relevance The findings of this study suggest that deprived neighborhood residency may increase the risk of African American men for prostate cancer and a related mortality, potentially through its association with systemic immune function and inflammation.
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Affiliation(s)
- Margaret S. Pichardo
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
- Department of Surgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia
| | - Tsion Zewdu Minas
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Catherine M. Pichardo
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
- Division of Cancer Control and Population Sciences, NCI, NIH, Rockville, Maryland
| | - Maeve Bailey-Whyte
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Wei Tang
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
- Data Science & Artificial Intelligence, R&D, AstraZeneca, Gaithersburg, Maryland
| | - Tiffany H. Dorsey
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - William Wooten
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center Biostatistics Shared Service, Baltimore
| | - Brid M. Ryan
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
| | - Christopher A. Loffredo
- Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Stefan Ambs
- Laboratory of Human Carcinogenesis, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, Maryland
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Racial Distribution of Neighborhood-Level Social Deprivation in a Retrospective Cohort of Prostate Cancer Survivors. Diseases 2022; 10:diseases10040075. [PMID: 36278574 PMCID: PMC9589959 DOI: 10.3390/diseases10040075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A better understanding of neighborhood-level factors’ contribution is needed in order to increase the precision of cancer control interventions that target geographic determinants of cancer health disparities. This study characterized the distribution of neighborhood deprivation in a racially diverse cohort of prostate cancer survivors. Methods: A retrospective cohort of 253 prostate cancer patients who were treated with radical prostatectomy from 2011 to 2019 was established at the Medical University of South Carolina. Individual-level data on clinical variables (e.g., stage, grade) and race were abstracted. Social Deprivation Index (SDI) and Healthcare Professional Shortage (HPS) status was obtained from the Robert Graham Center and assigned to participants based on their residential census tract. Data were analyzed with descriptive statistics and multivariable logistic regression. Results: The cohort of 253 men consisted of 168 white, 81 African American, 1 Hispanic and 3 multiracial men. Approximately 49% of 249 men lived in areas with high SDI (e.g., SDI score of 48 to 98). The mean for SDI was 44.5 (+27.4), and the range was 97 (1−98) for all study participants. African American men had a significantly greater likelihood of living in a socially deprived neighborhood compared to white men (OR = 3.7, 95% C.I. 2.1−6.7, p < 0.01), while men who lived in areas with higher HPS shortage status were significantly more likely to live in a neighborhood that had high SDI compared to men who lived in areas with lower HPS shortages (OR = 4.7, 95% C.I. = 2.1−10.7, p < 0.01). African Americans had a higher likelihood of developing biochemical reoccurrence (OR = 3.7, 95% C.I. = 1.7−8.0) compared with white men. There were no significant association between SDI and clinical characteristics of prostate cancer. Conclusions: This study demonstrates that SDI varies considerably by race among men with prostate cancer treated with radical prostatectomy. Using SDI to understand the social environment could be -particularly useful as part of precision medicine and precision public health approaches and could be used by cancer centers, public health providers, and other health care specialists to inform operational decisions about how to target health promotion and disease prevention efforts in catchment areas and patient populations.
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Chioreso C, Schroeder MC, Rupp IG, Ammann E, Carter KD, Lynch CF, Chrischilles EA, Charlton ME. Stage II/III Rectal Cancer Post-Treatment Surveillance Patterns of Care: A SEER- Medicare Study. ADVANCED RESEARCH IN GASTROENTEROLOGY & HEPATOLOGY 2021; 17:555972. [PMID: 37636523 PMCID: PMC10457021 DOI: 10.19080/argh.2021.17.555972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Introduction Despite high rectal cancer recurrence rates, knowledge on post-treatment surveillance utilization is limited. Hence, this study aims to estimate patterns of post-treatment surveillance and determine associated factors. Patients and Methods Retrospective study of 1,024 SEER-Medicare patients >65 years old diagnosed with stage II/III rectal cancer between 2007-2013. Logistic regression was used to determine factors associated with ≥1 colonoscopy, ≥2 physician visits, ≥2 carcinoembryonic antigen (CEA) tests and ≥2 computed tomographic colonography (CT) within 14 months after primary treatment. Results Fifty-five percent had ≥1 colonoscopy, 54% had ≥2 physician visits, 47% had ≥2 CEA tests and 20% had ≥2 CTs. In multivariable logistic models, younger age and receipt of chemoradiation therapy (vs none) were significant across all surveillance procedures while clinical factors such as comorbidity were not. Being married (OR=1.69; 95% CI: 1.26-2.26) and proximity to a high-volume hospital (≤15 vs >30 minutes, OR=1.56; 95% CI: 1.00-2.43) were associated with ≥1 colonoscopy. Female gender (OR=1.56; 95% CI: 1.17-2.09), being married (OR=1.56; 95% CI: 1.17-2.08), white race (OR=1.79; 95% CI: 1.23- 2.62) and surgery from high-volume surgeon (OR=1.47; 95% CI: 1.06-2.04) were associated with ≥2 physician visits. Female gender (OR=1.45; 95% CI: 1.08-1.95), being married (OR=1.46; 95% CI: 1.08-1.96) and surgery from high-volume surgeon (OR=1.55; 95% CI: 1.10-2.17) had higher ≥2 CEA tests. Conclusions Post-treatment surveillance remains low but is more common among younger patients and recipients of chemoradiation. Distinct profiles of patient characteristics and provider volume were associated with individual surveillance procedures suggesting the need for multicomponent strategies to increase surveillance.
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Affiliation(s)
- Catherine Chioreso
- Department of Epidemiology, University of Iowa College of Public Health, USA
| | - Mary C Schroeder
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, USA
| | | | - Eric Ammann
- Department of Epidemiology, University of Iowa College of Public Health, USA
| | - Knute D Carter
- Department of Biostatistics, University of Iowa College of Public Health, USA
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa College of Public Health, USA
- Iowa Cancer Registry, University of Iowa College of Public Health, USA
| | | | - Mary E Charlton
- Department of Epidemiology, University of Iowa College of Public Health, USA
- Iowa Cancer Registry, University of Iowa College of Public Health, USA
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Handorf E, Yin Y, Slifker M, Lynch S. Variable selection in social-environmental data: sparse regression and tree ensemble machine learning approaches. BMC Med Res Methodol 2020; 20:302. [PMID: 33302880 PMCID: PMC7727197 DOI: 10.1186/s12874-020-01183-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/27/2020] [Indexed: 11/18/2022] Open
Abstract
Background Social-environmental data obtained from the US Census is an important resource for understanding health disparities, but rarely is the full dataset utilized for analysis. A barrier to incorporating the full data is a lack of solid recommendations for variable selection, with researchers often hand-selecting a few variables. Thus, we evaluated the ability of empirical machine learning approaches to identify social-environmental factors having a true association with a health outcome. Methods We compared several popular machine learning methods, including penalized regressions (e.g. lasso, elastic net), and tree ensemble methods. Via simulation, we assessed the methods’ ability to identify census variables truly associated with binary and continuous outcomes while minimizing false positive results (10 true associations, 1000 total variables). We applied the most promising method to the full census data (p = 14,663 variables) linked to prostate cancer registry data (n = 76,186 cases) to identify social-environmental factors associated with advanced prostate cancer. Results In simulations, we found that elastic net identified many true-positive variables, while lasso provided good control of false positives. Using a combined measure of accuracy, hierarchical clustering based on Spearman’s correlation with sparse group lasso regression performed the best overall. Bayesian Adaptive Regression Trees outperformed other tree ensemble methods, but not the sparse group lasso. In the full dataset, the sparse group lasso successfully identified a subset of variables, three of which replicated earlier findings. Conclusions This analysis demonstrated the potential of empirical machine learning approaches to identify a small subset of census variables having a true association with the outcome, and that replicate across empiric methods. Sparse clustered regression models performed best, as they identified many true positive variables while controlling false positive discoveries. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-020-01183-9.
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Affiliation(s)
- Elizabeth Handorf
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Reimann 383, 333 Cottman Ave, Philadelphia, PA, 19111, USA.
| | - Yinuo Yin
- Cancer Prevention and Control, Fox Chase Cancer Center, Young Pavilion, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Michael Slifker
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Reimann 383, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Shannon Lynch
- Cancer Prevention and Control, Fox Chase Cancer Center, Young Pavilion, 333 Cottman Ave, Philadelphia, PA, 19111, USA
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Walker AF, Hu H, Cuttriss N, Anez-Zabala C, Yabut K, Haller MJ, Maahs DM. The Neighborhood Deprivation Index and Provider Geocoding Identify Critical Catchment Areas for Diabetes Outreach. J Clin Endocrinol Metab 2020; 105:5872808. [PMID: 32676640 PMCID: PMC7418444 DOI: 10.1210/clinem/dgaa462] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/13/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE In designing a Project ECHO™ type 1 diabetes (T1D) program in Florida and California, the Neighborhood Deprivation Index (NDI) was used in conjunction with geocoding of primary care providers (PCPs) and endocrinologists in each state to concurrently identify areas with low endocrinology provider density and high health risk/poverty areas. The NDI measures many aspects of poverty proven to be critical indicators of health outcomes. METHODS The data from the 2013-2017 American Community Survey (ACS) 5-year estimates were used to create NDI maps for California and Florida. In addition, geocoding and 30-minute drive-time buffers were performed using publicly available provider directories for PCPs and endocrinologists in both states by Google Geocoding API and the TravelTime Search Application Programming Interface (API). RESULTS Based on these findings, we defined high-need catchment areas as areas with (1) more than a 30-minute drive to the nearest endocrinologist but within a 30-minute drive to the nearest PCP; (2) an NDI in the highest quartile; and (3) a population above the median (5199 for census tracts, and 1394 for census block groups). Out of the 12 181 census tracts and 34 490 census block groups in California and Florida, we identified 57 tracts and 215 block groups meeting these criteria as high-need catchment areas. CONCLUSION Geospatial analysis provides an important initial methodologic step to effectively focus outreach efforts in diabetes program development. The integration of the NDI with geocoded provider directories enables more cost-effective and targeted interventions to reach the most vulnerable populations living with T1D.
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Affiliation(s)
- Ashby F Walker
- University of Florida Diabetes Institute, University of Florida, Gainesville, Florida
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida
- Correspondence and Reprint Requests: Ashby F. Walker, University of Florida Diabetes Institute; 1275 Center Drive, Box 1000309, Gainesville, FL 32610, USA. E-mail:
| | - Hui Hu
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Nicolas Cuttriss
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
| | | | - Katarina Yabut
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
| | - Michael J Haller
- University of Florida Diabetes Institute, University of Florida, Gainesville, Florida
- Department of Pediatrics, University of Florida, Gainesville, Florida
- Stanford Diabetes Research Center, Stanford, California
| | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
- Stanford Diabetes Research Center, Stanford, California
- Health Research and Policy (Epidemiology), Stanford University, Stanford, California
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10
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Crump C, Stattin P, Brooks JD, Stocks T, Sundquist J, Sieh W, Sundquist K. Early-Life Cardiorespiratory Fitness and Long-term Risk of Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:2187-2194. [PMID: 32856610 DOI: 10.1158/1055-9965.epi-20-0535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/30/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adolescence is a period of rapid prostatic growth, yet is understudied for susceptibility for future risk of prostate cancer. We examined cardiorespiratory fitness (CRF) in late adolescence in relation to long-term prostate cancer risk. METHODS A population-based cohort study was conducted of all 699,125 Swedish military conscripts during 1972-1985 (97%-98% of 18-year-old men) in relation to risk of prostate cancer overall, aggressive prostate cancer, and prostate cancer mortality during 1998-2017 (ages 50-65 years). CRF was measured by maximal aerobic workload, and prostate cancer was ascertained using the National Prostate Cancer Register. Muscle strength was examined as a secondary predictor. RESULTS In 38.8 million person-years of follow-up, 10,782 (1.5%) men were diagnosed with prostate cancer. Adjusting for sociodemographic factors, height, weight, and family history of prostate cancer, high CRF was associated with a slightly increased risk of any prostate cancer [highest vs. lowest quintile: incidence rate ratio (IRR), 1.10; 95% CI, 1.03-1.19; P = 0.008], but was neither significantly associated with aggressive prostate cancer (1.01; 0.85-1.21; P = 0.90) nor prostate cancer mortality (1.24; 0.73-2.13; P = 0.42). High muscle strength also was associated with a modestly increased risk of any prostate cancer (highest vs. lowest quintile: IRR, 1.14; 95% CI, 1.07-1.23; P < 0.001), but neither with aggressive prostate cancer (0.88; 0.74-1.04; P = 0.14) nor prostate cancer mortality (0.81; 0.48-1.37; P = 0.43). CONCLUSIONS High CRF or muscle strength in late adolescence was associated with slightly increased future risk of prostate cancer, possibly related to increased screening, but neither with risk of aggressive prostate cancer nor prostate cancer mortality. IMPACT These findings illustrate the importance of distinguishing aggressive from indolent prostate cancer and assessing for potential detection bias.
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Affiliation(s)
- Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York. .,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jan Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Weiva Sieh
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristina Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
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11
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Lynch SM, Handorf E, Sorice KA, Blackman E, Bealin L, Giri VN, Obeid E, Ragin C, Daly M. The effect of neighborhood social environment on prostate cancer development in black and white men at high risk for prostate cancer. PLoS One 2020; 15:e0237332. [PMID: 32790761 PMCID: PMC7425919 DOI: 10.1371/journal.pone.0237332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/23/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Neighborhood socioeconomic (nSES) factors have been implicated in prostate cancer (PCa) disparities. In line with the Precision Medicine Initiative that suggests clinical and socioenvironmental factors can impact PCa outcomes, we determined whether nSES variables are associated with time to PCa diagnosis and could inform PCa clinical risk assessment. MATERIALS AND METHODS The study sample included 358 high risk men (PCa family history and/or Black race), aged 35-69 years, enrolled in an early detection program. Patient variables were linked to 78 nSES variables (employment, income, etc.) from previous literature via geocoding. Patient-level models, including baseline age, prostate specific antigen (PSA), digital rectal exam, as well as combined models (patient plus nSES variables) by race/PCa family history subgroups were built after variable reduction methods using Cox regression and LASSO machine-learning. Model fit of patient and combined models (AIC) were compared; p-values<0.05 were significant. Model-based high/low nSES exposure scores were calculated and the 5-year predicted probability of PCa was plotted against PSA by high/low neighborhood score to preliminarily assess clinical relevance. RESULTS In combined models, nSES variables were significantly associated with time to PCa diagnosis. Workers mode of transportation and low income were significant in White men with a PCa family history. Homeownership (%owner-occupied houses with >3 bedrooms) and unemployment were significant in Black men with and without a PCa family history, respectively. The 5-year predicted probability of PCa was higher in men with a high neighborhood score (weighted combination of significant nSES variables) compared to a low score (e.g., Baseline PSA level of 4ng/mL for men with PCa family history: White-26.7% vs 7.7%; Black-56.2% vs 29.7%). DISCUSSION Utilizing neighborhood data during patient risk assessment may be useful for high risk men affected by disparities. However, future studies with larger samples and validation/replication steps are needed.
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Affiliation(s)
- Shannon M. Lynch
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Elizabeth Handorf
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | - Kristen A. Sorice
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | - Elizabeth Blackman
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | - Lisa Bealin
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | - Veda N. Giri
- Cancer Risk Assessment and Clinical Cancer Genetics Program, Departments of Medical Oncology, Cancer Biology, and Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Elias Obeid
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | - Camille Ragin
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
| | - Mary Daly
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States of America
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12
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Ethnic variation in prostate cancer detection: a feasibility study for use of the Stockholm3 test in a multiethnic U.S. cohort. Prostate Cancer Prostatic Dis 2020; 24:120-127. [PMID: 32641739 DOI: 10.1038/s41391-020-0250-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/20/2020] [Accepted: 06/30/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND The Stockholm3 test improves Gleason Grade Group ≥2 (GG ≥ 2) prostate cancer (PC) detection, however it has not been evaluated in an American cohort where clinical practice patterns and ethnicity differ. We aimed to identify subgroups within a Stockholm population with PC risk profiles matching American ethnicity-specific subgroups and compare the detection of PC and describe Stockholm3 performance within these subgroups. METHODS All men age 49-70 years presenting for prostate biopsies were evaluated at UIC from 2016 to 2019, as well as men in Stockholm from 2012 to 2014 in the STHLM3 study. Propensity scores (PS) were estimated for each person using logistic regression for age, PSA, prostate volume, family history of PC, 5-alpha reductase inhibitor use, and prior biopsy. 3:1 PS matching was performed for Stockholm to Chicago ethnicity-specific cohorts and odds ratios (OR) were computed to compare detection of GG ≥ 2 PC between groups. RESULTS 504 Chicago men and 6980 Stockholm men were included. In African American (AA) men, 51% had GG ≥ 2 PC detected, while in risk-matched Stockholm men, 34% had GG ≥ 2 PC detected (OR: 2.1, p < 0.001). There was no statistical difference in GG ≥ 2 PC detected when matching Stockholm men to non-Hispanic Caucasian men (31% vs. 24%, OR: 0.7, p = 0.30) or Hispanic Caucasian men (31% vs. 27%, OR: 1.2, p = 0.42). The AUC for the Stockholm3 test of the matched Stockholm cohorts for AA, non-Hispanic Caucasian, and Hispanic Caucasian men was 0.85, 0.89, and 0.90, respectively. CONCLUSIONS Using statistical techniques to simulate a multi-ethnic Chicago cohort within the STHLM3 population, we found an excess risk of GG ≥ 2 PC among AA men. Our hypothesis that the Stockholm3 may have good predictive value in a multiethnic cohort is strengthened, and that recalibration to at least AA men seems likely to be needed to obtain well-calibrated predictions.
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13
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Bluethmann SM, Wang M, Wasserman E, Chen C, Zaorsky NG, Hohl RJ, McDonald AC. Prostate cancer in Pennsylvania: The role of older age at diagnosis, aggressiveness, and environmental risk factors on treatment and mortality using data from the Pennsylvania Cancer Registry. Cancer Med 2020; 9:3623-3633. [PMID: 32212232 PMCID: PMC7221418 DOI: 10.1002/cam4.3003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 12/15/2022] Open
Abstract
Background To assess: (a) cancer treatment in prostate cancer survivors (PCS) by age at diagnosis (ADx) and prostate cancer (PC) aggressiveness; (b) potential impact on PC mortality; and (c) these results in the context of environmental/behavioral risk factors on PCS in Pennsylvania. Methods Prostate cancer survivors ages ≥40 years were identified from the 2004‐2014 Pennsylvania Cancer Registry (PCR). Demographic/clinical descriptors and PC treatment were extracted from PCR. Prostate cancer aggressiveness was defined by clinical/pathologic Gleason score and tumor stage. Logistic and Cox regression analyses tested associations between treatment received and PC‐specific mortality. County‐level data from the Pennsylvania BRFSS were used to estimate cancer‐related behavioral risk factors (eg, smoking, physical inactivity, fruit/vegetable consumption [FV], alcohol use) and used as covariates. Results There were 90 694 PCS ages 40‐105 years (mean age = 66.19 years, SD = 9.25) included. Most were non‐Hispanic white men (83%). Prostate cancer survivors ≥75 years were least likely to receive any treatment but men ages 65‐74 were more likely to receive combined therapies (OR = 1.47; 95% CI 1.28, 1.69) vs PCS ages 40‐54 years, controlling for covariates. Prostate cancer survivors 55‐75+ with aggressive PC who received any treatment vs no definitive treatment had significantly reduced mortality. Men from counties with high obesity and smoking rates were significantly less likely to receive any treatment than men living in counties with lower rates of these risk factors. Prostate cancer survivors who lived in counties with high rates of physical inactivity and had high rates of sufficient FV consumption were slightly more likely to receive cancer treatment vs no definitive treatment compared to men who lived in counties with high rates of physical activity and lower FV consumption. Conclusions We observed a general age‐related decline in receipt of treatment. Prostate cancer survivors ages ≥75 years were significantly less likely to get any cancer treatment compared to younger PCS. However, most men with more aggressive disease who received any treatment had greatly reduced PC mortality, regardless of age. Considering environmental/behavioral risk factors may attenuate PC risk and inform treatment options.
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Affiliation(s)
- Shirley M Bluethmann
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Ming Wang
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Emily Wasserman
- The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Chixiang Chen
- The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Nicholas G Zaorsky
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Raymond J Hohl
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
| | - Alicia C McDonald
- The Pennsylvania State University College of Medicine, Hershey, PA, USA.,Penn State Cancer Institute, Hershey, PA, USA
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14
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Lynch SM, Sorice K, Tagai EK, Handorf EA. Use of empiric methods to inform prostate cancer health disparities: Comparison of neighborhood-wide association study "hits" in black and white men. Cancer 2020; 126:1949-1957. [PMID: 32012234 DOI: 10.1002/cncr.32734] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Black men are more likely to die of prostate cancer (PCa) compared with white men. Factors ranging from genetics to neighborhood environment contribute to these disparities. However, unlike genetics, agnostic investigations that identify candidate variables from large-scale data, and that allow for empiric investigations into differential associations between neighborhood and PCa by race/ethnicity, to the authors' knowledge have not been well explored. Thus, herein, the authors built on their previously developed, empiric neighborhood-wide association study (NWAS) in white men and conducted a NWAS in black men to determine whether findings differed by race. METHODS Pennsylvania Cancer Registry data were linked to US Census data. For the NWAS in non-Hispanic black men, the authors evaluated the association between 14,663 neighborhood census variables and advanced PCa (11 high-stage and/or high-grade cases and 8632 low-stage and/or low-grade cases), adjusting for age, diagnosis year, spatial correlation, and multiple testing. Odds ratios and 95% credible intervals were reported. Replication of NWAS findings across black and white races was assessed using Bayesian mixed effects models. RESULTS Five variables related to housing (3 variables), education (1 variable), and employment and/or transportation (1 variable) were found to be significantly associated with advanced PCa in black men compared with 17 socioeconomic variables (mostly related to poverty and/or income) in white men. The top hit in black men was related to crowding in renter-occupied housing (odds ratio, 1.10; 95% credible interval, 1.001-1.12). Nine of 22 NWAS hits (4 of 5 hits in black men) were replicated across racial/ethnic groups. CONCLUSIONS Different neighborhood variables, or "candidates," were identified across race-specific NWASs. These findings and empiric approaches warrant additional study and may inform PCa racial disparities, particularly future gene-environment studies aimed at identifying patients and/or communities at risk of advanced PCa.
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Affiliation(s)
- Shannon M Lynch
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Kristen Sorice
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Erin K Tagai
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth A Handorf
- Population Studies Facility, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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15
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Soares SCM, de Camargo Cancela M, Migowski A, de Souza DLB. Digital rectal examination and its associated factors in the early detection of prostate cancer: a cross-sectional population-based study. BMC Public Health 2019; 19:1573. [PMID: 31775710 PMCID: PMC6881979 DOI: 10.1186/s12889-019-7946-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 11/13/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Digital rectal examination (DRE) is one of the most common strategies for prostate cancer early detection. However, the use for screening purposes has a controversial benefit and potential harms can occur due to false-positive results, overdiagnosis and overtreatment. The objective of this study is to calculate the prevalence and identify factors associated with the receipt of DRE in Brazilian men. METHODS We selected men older than 40 from a nationwide population-based survey (13,625 individuals) excluding those with prostate cancer diagnosis. Information was extracted from the most recent database of the Brazilian National Health Survey (PNS 2013). Statistical analysis was carried out to calculate incidence rate ratios, with 95% confidence intervals and p values, through multivariate analysis with Poisson regression and robust variance. RESULTS Men having private health insurance (63.3%; CI = 60.5-66.0) presented higher prevalence of DRE than those in the public health system (41.6%; CI = 39.8-43.4). The results show a positive association between DRE and men having private health insurance, aged 60-69, living with a spouse, never smokers, and living in urban areas. Among public health services users, this positive association was observed among men aged 70-79, living with a spouse, having bad/very bad health self-perception, abstainers, ex-smokers, with undergraduate studies, presenting four or more comorbidities, and residing in urban areas. CONCLUSIONS Prostate cancer screening with DRE is quite frequent in Brazil, specially among men with private health plans and better access to health services, healthier lifestyle and at more advanced ages, characteristics which increase the risk of overdiagnosis and overtreatment.
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Affiliation(s)
| | | | - Arn Migowski
- Cancer Early Detection Division, Brazilian National Cancer Institute (INCA), National Institute of Cardiology (INC), Rio de Janeiro, Brazil
| | - Dyego Leandro Bezerra de Souza
- Collective Health Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte Brazil
- Present Address: Universidade Federal do Rio Grande do Norte / Federal University of Rio Grande do Norte. Programa de Pós-Graduação em Saúde Coletiva / Graduate Program in Collective Health, Avenida Senador Salgado Filho 1787, CEP: 59010-000 Lagoa Nova, Natal, RN Brazil
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16
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Beyer KMM, Laud PW, Zhou Y, Nattinger AB. Housing discrimination and racial cancer disparities among the 100 largest US metropolitan areas. Cancer 2019; 125:3818-3827. [PMID: 31287559 DOI: 10.1002/cncr.32358] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/01/2019] [Accepted: 05/21/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cancer contributes substantially to the life expectancy gap between US blacks and whites, and racial cancer disparities remain stubborn to eradicate. Disparities vary geographically, suggesting that they are not inevitable. METHODS The authors examined the relationship between housing discrimination and the size of cancer disparities across large US metropolitan statistical areas (MSAs). MSA-level cancer disparities were measured using data from the US Centers for Disease Control and Prevention. Mortgage discrimination for each MSA was estimated using the Home Mortgage Disclosure Act database, and MSA racial segregation was determined using US Census data. Patterns of housing discrimination and cancer disparities were mapped, and the associations between these place-based factors and cancer disparities across MSAs were measured. RESULTS Black-to-white cancer mortality disparities (rate ratios) varied geographically, ranging from 1.50 to 0.86; 88% of mortality ratios were >1, indicating higher mortality for blacks. In areas with greater mortgage discrimination, the gap between black and white cancer mortality rates was larger (correlation coefficient [r] = 0.32; P = .001). This relationship persisted in sex-specific analyses (males, r = 0.37; P < .001; females, r = 0.23; P = .02) and in models controlling for confounders. In contrast, segregation was inconsistently associated with disparities. Adjusting for incidence disparities attenuated, but did not eliminate, the correlation between mortgage discrimination and mortality disparities (r = 0.22-0.24), suggesting that cancer incidence and survival each account for part of the mortality disparity. CONCLUSIONS Mortgage discrimination is associated with larger black-to-white cancer mortality disparities. Some areas are exceptions to this trend. Examination of these exceptions and of policies related to housing discrimination may offer novel strategies for explaining and eliminating cancer disparities.
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Affiliation(s)
- Kirsten M M Beyer
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Purushottam W Laud
- Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Yuhong Zhou
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ann B Nattinger
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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17
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Zhang J, Ye ZW, Townsend DM, Hughes-Halbert C, Tew KD. Racial disparities, cancer and response to oxidative stress. Adv Cancer Res 2019; 144:343-383. [PMID: 31349903 PMCID: PMC7104807 DOI: 10.1016/bs.acr.2019.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
At the intersection of genetics, biochemistry and behavioral sciences, there is a largely untapped opportunity to consider how ethnic and racial disparities contribute to individual sensitivity to reactive oxygen species and how these might influence susceptibility to various cancers and/or response to classical cancer treatment regimens that pervasively result in the formation of such chemical species. This chapter begins to explore these connections and builds a platform from which to consider how the disciplines can be strengthened further.
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Affiliation(s)
- Jie Zhang
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, United States.
| | - Zhi-Wei Ye
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, United States
| | - Danyelle M Townsend
- Department of Pharmaceutical and Biomedical Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Chanita Hughes-Halbert
- Department of Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, United States; Hollings Cancer Center, Medical University of South Carolina, Charleston, SC, United States
| | - Kenneth D Tew
- Department of Cell and Molecular Pharmacology and Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, United States
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18
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Racial and Ethnic Trends in Prostate Cancer Incidence and Mortality in Philadelphia, PA: an Observational Study. J Racial Ethn Health Disparities 2018; 6:371-379. [PMID: 30520002 DOI: 10.1007/s40615-018-00534-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/08/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND To learn more about local prostate cancer (PCa) disparities, we conducted descriptive analyses of the role of race and age in PCa using the Pennsylvania Cancer Registry data for Philadelphia (2005-2014). METHODS We focused on the most prevalent race/ethnic groups: white (33%), black (44%), and Hispanic (9%). Outcomes included PCa rates, tumor stage, and tumor grade. Percent change was used to describe changes in age-adjusted incidence and mortality rates. Frequency tables and logistic regression models were used to describe trends in proportions of advanced PCa by race and time. Race-by-time interaction terms were retained in the models if statistically significant. RESULTS PCa incidence was highest for black men over time. Incidence rates declined over time for all race groups (- 28% for white men to - 38% for Hispanic men). PCa mortality rates declined in a less universal manner (- 5% for blacks to - 32% for whites). Each year, odds increased across all race groups for advanced tumor stage (4% each year among white and Hispanic men and 9% each year among black men) and for advanced tumor grade (4% each year among white and black men and 23% each year among Hispanic men). Among younger men, black men experienced significantly increased odds of advanced tumor stage each year (8%) and Hispanics experienced significantly increased odds of advanced tumor grade each year (30%). CONCLUSIONS Black men remain at highest PCa risk relative to other racial/ethnic groups in Philadelphia. Younger black and Hispanic men are at particular risk for advanced PCa at diagnosis.
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19
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Rebbeck TR. Prostate Cancer Disparities by Race and Ethnicity: From Nucleotide to Neighborhood. Cold Spring Harb Perspect Med 2018; 8:a030387. [PMID: 29229666 PMCID: PMC6120694 DOI: 10.1101/cshperspect.a030387] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Prostate cancer (CaP) incidence, morbidity, and mortality rates vary substantially by race and ethnicity, with African American men experiencing among the highest CaP rates in the world. The causes of these disparities are multifactorial and complex, and likely involve differences in access to screening and treatment, exposure to CaP risk factors, variation in genomic susceptibility, and other biological factors. To date, the proportion of CaP that can be explained by environmental exposures is small and differences in the role factors play by race or ethnicity is poorly understood. In the absence of additional data, it is likely that environmental factors do not contribute greatly to CaP disparities. In contrast, CaP has one of the highest heritabilities of all major cancers and many CaP susceptibility genes have been identified. Some CaP loci, including the risk loci found at chromosome 8q24, have consistent effects in all racial/ethnic groups studied to date. However, replication of many susceptibility loci across race or ethnicity remains limited. It is likely that inequities in health care access strongly influences CaP disparities. CaP is a disease with a complex multifactorial etiology, and therefore any approach attempting to address racial/ethnic disparities in CaP must consider the many sources that influence risk, outcomes, and disparities.
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Affiliation(s)
- Timothy R Rebbeck
- Dana Farber Cancer Institute and Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02215
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20
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A Prostate Cancer Composite Score to Identify High Burden Neighborhoods. Prev Med 2018; 112:47-53. [PMID: 29625131 DOI: 10.1016/j.ypmed.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/15/2018] [Accepted: 04/02/2018] [Indexed: 12/29/2022]
Abstract
This study presents a novel geo-based metric to identify neighborhoods with high burdens of prostate cancer, and compares this metric to other methods to prioritize neighborhoods for prostate cancer interventions. We geocoded prostate cancer patient data (n = 10,750) from the Pennsylvania cancer registry from 2005 to 2014 by Philadelphia census tract (CT) to create standardized incidence ratios (SIRs), mortality ratios (SMRs), and mean prostate cancer aggressiveness. We created a prostate cancer composite (PCa composite) variable to describe CTs by mean-centering and standard deviation-scaling the SMR, SIR, and mean aggressiveness variables and summing them. We mapped CTs with the 25 highest PCa composite scores and compared these neighborhoods to CTs with the 25 highest percent African American residents and the 25 lowest median household incomes. The mean PCa composite score among the 25 highest CTs was 4.65. Only seven CTs in Philadelphia had both one of the highest PCa composite scores and the highest percent African American residents. Only five CTs had both the highest PCa composites and the lowest median incomes. Mean PCa composite scores among CTs with the highest percent African American residents and lowest median incomes were 2.08 and 1.19, respectively. The PCa composite score is an accurate metric for prioritizing neighborhoods based on burden. If neighborhoods were prioritized based on percent African American or median income, priority neighborhoods would have been very different and not based on PCa burden. These methods can be utilized by public health decision-makers when tasked to prioritize and select neighborhoods for cancer interventions.
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Lynch SM, Mitra N, Ravichandran K, Mitchell J, Spangler E, Zhou W, Paskett ED, Gehlert S, DeGraffinreid C, Stowe R, Dubowitz T, Riethman H, Branas CC, Peek MK, Rebbeck TR. Telomere Length and Neighborhood Circumstances: Evaluating Biological Response to Unfavorable Exposures. Cancer Epidemiol Biomarkers Prev 2018; 26:553-560. [PMID: 28373169 DOI: 10.1158/1055-9965.epi-16-0554] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/27/2016] [Accepted: 02/10/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Multilevel frameworks suggest neighborhood circumstances influence biology; however, this relationship is not well studied. Telomere length (TL) shortening has been associated with individual-level and neighborhood-level exposures and disease and may provide insights into underlying biologic mechanisms linking neighborhood with biology. To support neighborhood-biology investigations, we sought to determine the independent effect of neighborhood exposures on TL using standard multilevel linear regression models and quantile regression, a nonlinear, social science method applicable for testing the biologic hypothesis that extremes of the TL distribution are related to poor outcomes.Methods: In a multicenter, cross-sectional study, blood TL was measured in 1,488 individuals from 127 census tracts in three U.S. regions using terminal restriction fragment assays. Multilevel linear and quantile regression models were adjusted for individual-level race, education, perceived stress, and depression. Neighborhood exposures included population density, urban/residential crowding, residential stability/mobility, and socioeconomic status.Results: TL was not associated with any neighborhood variable using linear models, but quantile regression revealed inverse associations between population density and urban crowding at the lower tails of the TL distribution [5th (population density P = 0.03; urban crowding P = 0.002), 50th (both P < 0.001), 75th percentiles (both P < 0.001)]. TL was related to residential stability at the upper tail (95th percentile P = 0.006).Conclusions: Findings support the use of nonlinear statistical methods in TL research and suggest that neighborhood exposures can result in biological effects.Impact: TL may serve as an underlying example of a biologic mechanism that can link neighborhood with biology, thus supporting multilevel investigations in future studies. Cancer Epidemiol Biomarkers Prev; 26(4); 553-60. ©2017 AACRSee all the articles in this CEBP Focus section, "Geospatial Approaches to Cancer Control and Population Sciences."
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Affiliation(s)
- Shannon M Lynch
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania. .,Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - Jonathan Mitchell
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elaine Spangler
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wenting Zhou
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Harold Riethman
- Wistar Institute, Philadelphia, Pennsylvania.,Old Dominion University, Norfolk, Virginia
| | - Charles C Branas
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - M K Peek
- University of Texas Medical Branch, Galveston, Texas
| | - Timothy R Rebbeck
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Dana Farber Cancer Institute, Boston, Massachusetts
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Percy-Laurry A, Altekruse SF, Hossain MB, O'Keefe AM, Johnson NJ, Kamangar F. Association Between Socioeconomic Status and Tumor Grade Among Black Men with Prostate Cancer. J Natl Med Assoc 2017; 110:53-57. [PMID: 29510844 DOI: 10.1016/j.jnma.2017.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prostate cancer affects black men disproportionately. Black men have an increased incidence of prostate cancer diagnoses at earlier ages and higher grade as indicated by Gleason score, compared to other races. This study investigates the impact of socioeconomic status (SES) on prostate cancer tumor grade among black men. METHODS Black men with a prostate cancer diagnosis during 1973-2011 were examined using individual-level data from the SEER NLMS database. Logistic regression model estimated the likelihood of receiving a diagnosis of high versus low grade prostate cancer based on self-reported SES status at the time of diagnosis. RESULTS Men who completed high school only were statistically significantly more likely to have a higher prostate cancer grade than those with a bachelor's degree or higher. However, there was no dose-response effect across educational strata. Retirees were 30% less likely to have higher grade tumors compared to those who were employed. CONCLUSIONS SES differences among black men did not fully explain the high grade of prostate cancer. Further research is needed on the biology of the disease and to assess access to medical care and prostate health education, discrimination, stress exposures, and social norms that might contribute to the aggressiveness of prostate cancer among black men.
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Affiliation(s)
- Antoinette Percy-Laurry
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA.
| | - Sean F Altekruse
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Mian B Hossain
- Morgan State University, School of Community Health and Policy, Baltimore, MD, USA
| | - Anne Marie O'Keefe
- Morgan State University, School of Community Health and Policy, Baltimore, MD, USA
| | | | - Farin Kamangar
- Morgan State University, School of Community Health and Policy, Baltimore, MD, USA
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23
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Lynch SM, Mitra N, Ross M, Newcomb C, Dailey K, Jackson T, Zeigler-Johnson CM, Riethman H, Branas CC, Rebbeck TR. A Neighborhood-Wide Association Study (NWAS): Example of prostate cancer aggressiveness. PLoS One 2017; 12:e0174548. [PMID: 28346484 PMCID: PMC5367705 DOI: 10.1371/journal.pone.0174548] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 03/11/2017] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Cancer results from complex interactions of multiple variables at the biologic, individual, and social levels. Compared to other levels, social effects that occur geospatially in neighborhoods are not as well-studied, and empiric methods to assess these effects are limited. We propose a novel Neighborhood-Wide Association Study(NWAS), analogous to genome-wide association studies(GWAS), that utilizes high-dimensional computing approaches from biology to comprehensively and empirically identify neighborhood factors associated with disease. METHODS Pennsylvania Cancer Registry data were linked to U.S. Census data. In a successively more stringent multiphase approach, we evaluated the association between neighborhood (n = 14,663 census variables) and prostate cancer aggressiveness(PCA) with n = 6,416 aggressive (Stage≥3/Gleason grade≥7 cases) vs. n = 70,670 non-aggressive (Stage<3/Gleason grade<7) cases in White men. Analyses accounted for age, year of diagnosis, spatial correlation, and multiple-testing. We used generalized estimating equations in Phase 1 and Bayesian mixed effects models in Phase 2 to calculate odds ratios(OR) and confidence/credible intervals(CI). In Phase 3, principal components analysis grouped correlated variables. RESULTS We identified 17 new neighborhood variables associated with PCA. These variables represented income, housing, employment, immigration, access to care, and social support. The top hits or most significant variables related to transportation (OR = 1.05;CI = 1.001-1.09) and poverty (OR = 1.07;CI = 1.01-1.12). CONCLUSIONS This study introduces the application of high-dimensional, computational methods to large-scale, publically-available geospatial data. Although NWAS requires further testing, it is hypothesis-generating and addresses gaps in geospatial analysis related to empiric assessment. Further, NWAS could have broad implications for many diseases and future precision medicine studies focused on multilevel risk factors of disease.
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Affiliation(s)
- Shannon M. Lynch
- Fox Chase Cancer Center, Cancer Prevention and Control, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Nandita Mitra
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Michelle Ross
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Craig Newcomb
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Karl Dailey
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Tara Jackson
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | | | - Harold Riethman
- Old Dominion University, Norfolk, Virginia, United States of America
| | - Charles C. Branas
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
- Columbia University, Mailman School of Public Health, New York, New York, United States of America
| | - Timothy R. Rebbeck
- Dana Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
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24
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Schwartz K, Ruterbusch JJ, Colt JS, Miller DC, Chow WH, Purdue MP. Racial disparities in overall survival among renal cell carcinoma patients with young age and small tumors. Cancer Med 2015; 5:200-8. [PMID: 26710924 PMCID: PMC4735764 DOI: 10.1002/cam4.578] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 08/07/2015] [Accepted: 08/10/2015] [Indexed: 12/22/2022] Open
Abstract
We examined the overall survival of a population‐based cohort of black and white patients with renal cell carcinoma (RCC) to better understand the paradox of poorer RCC survival despite more frequent diagnosis at lower stage among blacks. Renal cell carcinoma patients (699 white, 252 black) diagnosed between 2002 and 2007 in metropolitan Detroit were followed for vital status in the Detroit Surveillance, Epidemiology and End Results (SEER) registry. Hazard ratios (HR) of death for black versus white race and 95% confidence intervals (CIs) were calculated using Cox proportional hazard models stratified by demographic and prognostic factors, and in models successively adjusted for clinical factors, comorbidities, and socioeconomic factors. Mean follow‐up time was 88.4 months for white patients and 89.6 months for black patients (P = 0.49), with 202 white deaths and 89 black deaths (P = 0.06). While black race was weakly associated with poorer overall survival (P = 0.053), black patients <65 years at diagnosis or with tumors <4 cm in size had significantly poorer survival than their white counterparts (HR = 1.46, 95% CI 1.06–2.01 and HR = 2.15, 95% CI 1.51–3.06, respectively). The racial disparities within these two subgroups were minimally affected by adjustment for clinical/treatment factors (HR = 1.49, 95% CI 1.01–2.19 and HR = 1.95, 95% CI 1.27–2.99), but were substantially reduced when renal‐relevant comorbidities were added (HR = 1.30, 95% CI 0.89–1.91 and HR = 1.76, 95% CI 1.16–2.66). After further adjustment for socioeconomic factors, the survival disparities were essentially null (HR = 1.14, 95% CI 0.71–1.85 and HR = 1.15, 95% CI 0.67–1.98). In this population‐based sample of RCC patients, younger black patients and those with small tumors had poorer overall survival than whites. The disparity was explained primarily by racial differences in renal‐relevant comorbidities, particularly chronic renal failure, and socioeconomic deprivation. Future research should focus on younger patients and those with smaller tumors to better understand how these factors may contribute to the survival disparity.
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Affiliation(s)
- Kendra Schwartz
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan
| | - Julie J Ruterbusch
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, Michigan.,Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan
| | - Joanne S Colt
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - David C Miller
- Department of Urology, University of Michigan Medicine School, Ann Arbor, Michigan
| | - Wong-Ho Chow
- Department of Epidemiology, Division of Cancer Prevention and Population Sciences, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
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Bazemore AW, Cottrell EK, Gold R, Hughes LS, Phillips RL, Angier H, Burdick TE, Carrozza MA, DeVoe JE. "Community vital signs": incorporating geocoded social determinants into electronic records to promote patient and population health. J Am Med Inform Assoc 2015; 23:407-12. [PMID: 26174867 DOI: 10.1093/jamia/ocv088] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/26/2015] [Indexed: 11/14/2022] Open
Abstract
Social determinants of health significantly impact morbidity and mortality; however, physicians lack ready access to this information in patient care and population management. Just as traditional vital signs give providers a biometric assessment of any patient, "community vital signs" (Community VS) can provide an aggregated overview of the social and environmental factors impacting patient health. Knowing Community VS could inform clinical recommendations for individual patients, facilitate referrals to community services, and expand understanding of factors impacting treatment adherence and health outcomes. This information could also help care teams target disease prevention initiatives and other health improvement efforts for clinic panels and populations. Given the proliferation of big data, geospatial technologies, and democratization of data, the time has come to integrate Community VS into the electronic health record (EHR). Here, the authors describe (i) historical precedent for this concept, (ii) opportunities to expand upon these historical foundations, and (iii) a novel approach to EHR integration.
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Affiliation(s)
- Andrew W Bazemore
- Robert Graham Center for Policy Studies in Primary Care, Washington, DC, USA
| | - Erika K Cottrell
- OCHIN, Inc., Portland, OR, USA Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Rachel Gold
- OCHIN, Inc., Portland, OR, USA Kaiser Permanente NW, Center for Health Research, Portland, OR, USA
| | - Lauren S Hughes
- Robert Wood Johnson Foundation Clinical Scholars Program®, Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Timothy E Burdick
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, USA
| | - Mark A Carrozza
- HealthLandscape, American Academy of Family Physicians, Cincinnati, OH, USA
| | - Jennifer E DeVoe
- OCHIN, Inc., Portland, OR, USA Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Peterson CE, Rauscher GH, Johnson TP, Kirschner CV, Barrett RE, Kim S, Fitzgibbon ML, Joslin CE, Davis FG. The association between neighborhood socioeconomic status and ovarian cancer tumor characteristics. Cancer Causes Control 2014; 25:633-7. [DOI: 10.1007/s10552-014-0357-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 02/04/2014] [Indexed: 10/25/2022]
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27
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Lynch SM, Rebbeck TR. Bridging the gap between biologic, individual, and macroenvironmental factors in cancer: a multilevel approach. Cancer Epidemiol Biomarkers Prev 2013; 22:485-95. [PMID: 23462925 DOI: 10.1158/1055-9965.epi-13-0010] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
To address the complex nature of cancer occurrence and outcomes, approaches have been developed to simultaneously assess the role of two or more etiologic agents within hierarchical levels including the: (i) macroenvironment level (e.g., health care policy, neighborhood, or family structure); (ii) individual level (e.g., behaviors, carcinogenic exposures, socioeconomic factors, and psychologic responses); and (iii) biologic level (e.g., cellular biomarkers and inherited susceptibility variants). Prior multilevel approaches tend to focus on social and environmental hypotheses, and are thus limited in their ability to integrate biologic factors into a multilevel framework. This limited integration may be related to the limited translation of research findings into the clinic. We propose a "Multi-level Biologic and Social Integrative Construct" (MBASIC) to integrate macroenvironment and individual factors with biology. The goal of this framework is to help researchers identify relationships among factors that may be involved in the multifactorial, complex nature of cancer etiology, to aid in appropriate study design, to guide the development of statistical or mechanistic models to study these relationships, and to position the results of these studies for improved intervention, translation, and implementation. MBASIC allows researchers from diverse fields to develop hypotheses of interest under a common conceptual framework, to guide transdisciplinary collaborations, and to optimize the value of multilevel studies for clinical and public health activities.
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Affiliation(s)
- Shannon M Lynch
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 243 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA.
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28
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A prospective study of socioeconomic status, prostate cancer screening and incidence among men at high risk for prostate cancer. Cancer Causes Control 2012; 24:297-303. [PMID: 23224323 DOI: 10.1007/s10552-012-0108-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 11/15/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE 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.
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29
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Major JM, Norman Oliver M, Doubeni CA, Hollenbeck AR, Graubard BI, Sinha R. Socioeconomic status, healthcare density, and risk of prostate cancer among African American and Caucasian men in a large prospective study. Cancer Causes Control 2012; 23:1185-91. [PMID: 22674292 PMCID: PMC3405544 DOI: 10.1007/s10552-012-9988-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/03/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES 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.
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Affiliation(s)
- Jacqueline M Major
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD 20852, USA.
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Salinas JJ, Shah M, Abdelbary B, Gay JL, Sexton K. Application of a novel method for assessing cumulative risk burden by county. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012; 9:1820-35. [PMID: 22754475 PMCID: PMC3382739 DOI: 10.3390/ijerph9051820] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Revised: 04/28/2012] [Accepted: 05/02/2012] [Indexed: 11/16/2022]
Abstract
The purpose of this study is to apply the Human Security Index (HSI) as a tool to detect social and economic cumulative risk burden at a county-level in the state of Texas. The HSI is an index comprising a network of three sub-components or "fabrics"; the Economic, Environmental, and Social Fabrics. We hypothesized that the HSI will be a useful instrument for identifying and analyzing socioeconomic conditions that contribute to cumulative risk burden in vulnerable counties. We expected to identify statistical associations between cumulative risk burden and (a) ethnic concentration and (b) geographic proximity to the Texas-Mexico border. Findings from this study indicate that the Texas-Mexico border region did not have consistently higher total or individual fabric scores as would be suggested by the high disease burden and low income in this region. While the Economic, Environmental, Social Fabrics (including the Health subfabric) were highly associated with Hispanic ethnic concentration, the overall HSI and the Crime subfabric were not. In addition, the Education, Health and Crime subfabrics were associated with African American racial composition, while Environment, Economic and Social Fabrics were not. Application of the HSI to Texas counties provides a fuller and more nuanced understanding of socioeconomic and environmental conditions, and increases awareness of the role played by environmental, economic, and social factors in observed health disparities by race/ethnicity and geographic region.
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Affiliation(s)
- Jennifer J. Salinas
- School of Public Health, University of Texas Health Science Center at Houston, Brownsville Regional Campus, RAHC, UTB 80 Fort Brown, Brownsville, TX 78520, USA; (M.S.); (B.A.); (K.S.)
- Author to whom correspondence should be addressed; ; Tel.: +1-956-882-5755; Fax: +1-956-882-5152
| | - Manasi Shah
- School of Public Health, University of Texas Health Science Center at Houston, Brownsville Regional Campus, RAHC, UTB 80 Fort Brown, Brownsville, TX 78520, USA; (M.S.); (B.A.); (K.S.)
| | - Bassent Abdelbary
- School of Public Health, University of Texas Health Science Center at Houston, Brownsville Regional Campus, RAHC, UTB 80 Fort Brown, Brownsville, TX 78520, USA; (M.S.); (B.A.); (K.S.)
| | - Jennifer L. Gay
- Health Promotion & Behavior, The University of Georgia, 330 River Road, 329 Ramsey Center, Athens, GA 30602, USA;
| | - Ken Sexton
- School of Public Health, University of Texas Health Science Center at Houston, Brownsville Regional Campus, RAHC, UTB 80 Fort Brown, Brownsville, TX 78520, USA; (M.S.); (B.A.); (K.S.)
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