We compared clinical differences in PCa metastatic and treatment status at presentation among the four major HA subgroups by country of origin (Mexicans, Puerto Ricans, Cubans, and Central/South Americans) with non-Hispanic whites (NHW) as a reference population. Using NHWs as a reference group, as opposed to a specific H subgroup, allows for analysis of disproportionate PCa burden. Our results showed that men of Mexican origin presented with worse disease characteristics when compared to both NHW men and HAs of other origins and had a higher proportion of metastatic disease and lower odds of receiving treatment on multivariate analysis and after adjusting pertinent variables. The metastatic presentation was used as a primary endpoint rather than overall survival, given the long lead time in PCa mortality. Similarly, when analyzing baseline characteristics of H as an aggregate compared to NHWs, the effect size between groups decreased considerably, pointing out the importance of stratifying H by country of origin to identify subgroup-specific differences that could be more easily targeted.
Our study revealed an emerging disproportion of metastatic disease presentation in Mexican men, cautiously showing an opportunity for targeted interventions to help improve patient education and community outreach. However, more research into potentially contributing biological and socioeconomic factors unique to certain Hispanic subgroups is encouraged. Although the proportion is dropping, HAs are more likely to be under or uninsured, which can delay screening and treatment initiation. In our study, South/Central Americans had a higher percentage of uninsured followed by Mexican Americans. Legal status may be a limitation since legal documentation is necessary to obtain health insurance. Moreover, discrimination, fear of deportation, and language barriers may cause mistrust in the healthcare system and underutilization of healthcare. Finally, education status could contribute to more advanced disease at presentation and lower treatment rates.
Written by: Ricardo J. Estrada-Mendizabal,1 Alejandro Recio-Boiles,2 Juan Chipollini3
- School of Medicine and Health Science, Tecnologico de Monterrey, Sertoma, Monterrey, N.L, Mexico
- University of Arizona Cancer Center, Tucson, AZ, United States
- Department of Urology, University of Arizona, Tucson, AZ, United States