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.
Written by:
Rundle A, Neckerman KM, Sheehan D, Jankowski M, Kryvenko ON, Tang D, Rybicki BA. Are you the author?
Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York City, NY, 10032, USA.
Reference: Cancer Causes Control. 2012 Dec 8. Epub ahead of print.
doi: 10.1007/s10552-012-0108-6
PubMed Abstract
PMID: 23224323
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