Socio-economic and demographical factors contribute to disparity in prostate cancer (PCa) outcomes. We examined the impact of area of deprivation index (ADI) and race on PCa incidence and lethality in a North-American cohort.
Our cohort included men who received at least one PSA test within our Health System (1995-2022). An ADI score was assigned to each patient based on their residential census block, ranked as a percentile of deprivation relative to the national level. Individuals were further categorized into quartiles, where the fourth one (ADI 75-100) represented those living in the most deprived areas. We investigated PCa incidence and lethality, using cumulative incidence estimates and competing-risk regression. An ADIxRace interaction term examined whether the relationship between ADI and outcomes varied based on race.
We included 134,366 patients, 25% of whom were NHB. Median (IQR) follow-up was 8.8 (5-17) years. At multivariate analysis, individuals from the third (ADI 50-74, 95% CI: 0.83-0.95) and the fourth quartile (ADI ≥ 75, 95% CI: 0.75-0.86) showed significant reduced HRs for PCa incidence, when compared with the first quartile (ADI < 25, all p < .001). In contrast to the overall cohort, PCa incidence increased with ADI in NHB men, who were persistently at higher hazard for both PCa incidence and lethality than NHW, across all ADI strata (all p < .001).
Living in more deprived areas was associated with lower PCa incidence and higher lethal disease rate. Conversely, PCa incidence increased with ADI for NHB, who consistently showed worse outcomes than NHW individuals, regardless of ADI.
JNCI cancer spectrum. 2024 Nov 22 [Epub ahead of print]
Marco Finati, Alex Stephens, Giuseppe Ottone Cirulli, Giuseppe Chiarelli, Shane Tinsley, Chase Morrison, Akshay Sood, Nicolò Buffi, Giovanni Lughezzani, Andrea Salonia, Alberto Briganti, Francesco Montorsi, Gian Maria Busetto, Craig Rogers, Giuseppe Carrieri, Firas Abdollah
VUI Center for Outcomes Research, Analysis, and Evaluation, Henry Ford Health System, Detroit, MI, USA., Public Health Sciences, Henry Ford Health System, Detroit, MI, USA., Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Division of Oncology, Unit of Urology, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy., Department of Urology, IRCCS Humanitas Research Hospital, Humanitas University, Milan, Italy., Department of Urology and Renal Transplantation, University of Foggia, Foggia, Italy., University of Michigan Medical School, Ann Arbor, Michigan.