Clinical factors influence racial disparities in prostate cancer survival

Recent findings indicate that patients residing in counties with lower income and education levels experience worse 5-year prostate cancer-specific mortality, though the relationship varies depending on race, ethnicity, disease severity, and health care utilization.^1,2

Investigators found an overall 5-year prostate cancer-specific survival of 94% among all patients included in the study.

Lead author of the study Sean Clouston, PhD, explained in correspondence with Urology Times®, “We studied incidence and survival from prostate cancer in the [Survival, Epidemiology, and End Results] SEER database and found that survival was worse in men from different racial/ethnic backgrounds, but that racial disparities dissipated once we considered clinical measures of timeliness of care.” Clouston is a professor of family, population, and preventive medicine and the director of research in public health at Stony Brook University in Stony Brook, New York.

For the study, data from 239,613 prostate cancer cases were obtained from the SEER database, linked to county-level socioeconomic status. The investigators assessed outcomes among non-Hispanic White patients, non-Hispanic Black patients, non-Hispanic Asian or Pacific Islander patients, non-Hispanic American Indian or Alaska Native patients, and Hispanic patients in the US.

Investigators found an overall 5-year prostate cancer-specific survival of 94% among all patients included in the study. When looking at specific racial/ethnic groups, 5-year survival ranged between 93% and 94% for all groups except American Indian or Alaska Native patients, who experienced a 5-year prostate-cancer specific survival of 88%.

Overall, data showed that patients in counties with lower education levels, higher rates of unemployment, and increased rates of poverty experienced the worst prostate cancer-specific survival. Specifically, patients residing in counties with the worst poverty and income levels had a 38% increased risk of prostate cancer mortality, and patients residing in areas with the lowest education levels had a 33% increased risk of prostate cancer mortality. Conversely, patients residing in areas with the highest education levels had a 23% decreased prostate cancer mortality risk.

However, when looking at Black patients’ outcomes specifically, better education did not correlate to improved survival. The authors note that this finding suggests interventions designed to improve outcomes on this level may not be beneficial.

“Such findings could also support the diminishing returns hypothesis where minorities might not achieve the same health gains at higher [socioeconomic status] as those of their White counterparts with similar [socioeconomic status],” the author write.

The differences in the association between socioeconomic variables and prostate cancer outcomes may be in part due to health care utilization and disease severity, according to the authors.

Data showed that prostate cancer severity (stage and grade) and health care utilization (“Gleason score not documented” and surgery) were associated with lower county-level socioeconomic status and increased the risk of 5-year cancer-specific mortality. Notably, insurance status did not significantly influence the relationship between disease severity/health care utilization and socioeconomic status, although having insurance was associated with improved survival in the multilevel analysis.

Clouston commented, “[These] results imply that prostate cancer survival could be improved, especially in historically under-served groups, by improving the timeliness of access to medical care.”

Further, the investigators found that Black patients had a 1.6 times greater risk of prostate cancer mortality compared with White patients at the group-level analysis, though the risk decreased when accounting for individual and clinical covariates and county-level characteristics. Hispanic patients similarly demonstrated a greater risk of prostate cancer specific mortality compared with White patients, though they demonstrated lower mortality compared with White patients when adjustments for severity and county-level characteristics were made.

The authors indicate that further research is needed to assess the long-term effect of these factors.

References

1. Clouston SAP, Khoury CJE. Racial/ethnic disparities in prostate cancer 5-year survival: The role of health-care access and disease severity. Cancers (Basel). 2023;15(17):4284. doi: 10.3390/cancers15174284

2. Sociomedical factors may put Black men at higher risk of death from prostate cancer. News release. Stony Brook University. Published online and accessed September 25, 2023. https://www.newswise.com/articles/sociomedical-factors-may-put-black-men-at-higher-risk-of-death-from-prostate-cancer