Associations of Neighborhood Deprivation Index, Household Income, Diversity, and Pollution with Prostate Cancer Incidence and Mortality from 2000 - 2020 in Rhode Island
Borivoj Golijanin, BS, Sarah Andrea, PhD, Justin Bessette, BS, Rebecca Ortiz, BA, Philip Caffery, PhD, Timothy O'Rourke, MD, Christopher Tucci, MS, RN-BC, CURN, NE-BC, Gyan Pareek, MD, Dragan J. Golijanin, MD.
The Minimally Invasive Urology Institute, The Miriam Hospital; The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Introduction: Despite advances in prostate cancer (PCa) screening and treatment, socioeconomic inequities continue to impact both PCa risk and survival. We investigated the association between neighborhood sociodemographic and neighborhood pollution composition and PCa incidence and survival. Materials & Methods: 4,614 patients received treatment for PCa from 2000 to 2020 Brown University affiliated hospitals. Patient addresses were linked to census tract-level data on neighborhood sociodemographic composition and locations of pollution sources. Pollution sources include superfund sites, sanitary and solid waste facilities, and leaking underground storage tanks. Using Poisson and Cox proportional hazards models, we assessed incidence of PCa as well as overall and progression free survival as a function of neighborhood pollution, area deprivation index (ADI), median household income (MHI), and racial composition quartiles (Q1, lowest; Q4 highest) in separate models adjusted for year and age at time of diagnosis. Results: Average age at time of diagnosis was 65 years, 82% of men were non-Hispanic white, and mean overall survival was 86 months. Likelihood of PCa diagnosis was positively correlated with greater neighborhood pollution (Q4 vs Q1: RR: 1.26; 95% CI:1.09,1.45), greater composition of non-Hispanic white residents (Q4 vs Q1: RR:1.37; 95% CI:1.18,1.59), and higher neighborhood MHI (Q4 vs Q1: RR:1.46;95% CI:1.46,1.96). Overall, 5-, 3-, and 1-year survival rates are 75%, 82%, and 92%, respectively. Likelihood of dying within 5-years of diagnosis was greatest for those in neighborhoods with high ADI (Q4 vs Q1: HR:1.33; 95% CI:1.05,1.69) and lowest for those in predominantly white neighborhoods (Q4 vs Q1: HR:0.76;95% CI: 0.60, 0.96) and neighborhoods with higher MHI (Q4 vs Q1: HR:0.72;95% CI:0.56- 0.91). Conclusions: Neighborhood sociodemographic and pollution composition are associated with both incidence of PCa diagnosis and survival, such that those in more polluted and more affluent areas are both more likely to have a PCa diagnosis (Figure 1 and Figure 2) and to experience greater overall survival. These findings are in line with observed associations between higher individual-level income and higher probability of both detection of PCa and access to curative treatment in the literature. These findings might be explained by differential survival, and the inequities that affect different neighborhoods, racial groups, and socioeconomic statuses, including access to timely screening and treatment. Future research and policy programs may target specific areas of the state to better address the screening and treatment needs in high-risk neighborhoods and PCa hotspots. 
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