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Associations Between Social Vulnerability and Metastatic Prostate Cancer at Diagnosis from 2018-2023 in Rhode Island
Angelo Blancaflor, BS1, Tim Wynter, BS
1, Borivoj Golijanin, MD
2, Natalia Alzate, BS
2, Taylor Braunagel, MS
2, Elias Hyams, MD
2.
1The Warren Alpert Medical School of Brown University, Providence, RI, USA,
2Brown University Health, Minimally Invasive Urology Institute, Providence, RI, USA.
BACKGROUND: Socioeconomic and environmental factors can contribute to delayed prostate cancer (PCa) diagnosis and, thus, elevated rates of metastatic disease. This study examined the relationship between the Area Deprivation Index (ADI) and the Vizient Vulnerability Index (VVI), and its subdomains, with the presence of metastatic disease at the time of cancer diagnosis.
METHODS: A retrospective cohort study analyzed 1,019 patients who received treatment at the Brown University Health Cancer Institute from 2018-2023 with ZIP code-linked ADI and VVI data. Using the AJCC staging of patients at the time of diagnosis, the analysis used binary logistic regression to determine how metastasis correlated with ADI, VVI, and VVI subdomains.
RESULTS: 24.9% of patients in the cohort presented with metastatic PCa at diagnosis. In the full logistic regression model, the “clean environment” subdomain of the VVI was significantly associated with metastatic disease (OR = 1.88, 95% CI: 1.11-3.17, p = 0.019). In a reduced model including only the clean environment and healthcare subdomains, both remained statistically significant: environmental vulnerability (OR = 1.39, 95% CI: 1.11-1.76, p = 0.005) and healthcare vulnerability (OR = 2.02, 95% CI: 1.05-3.86, p = 0.034).
CONCLUSIONS: Patients residing in areas with greater environmental and healthcare-accessibility vulnerabilities have increased odds of presenting with metastatic disease at the time of PCa diagnosis. These findings provide further evidence that structural socioeconomic factors are associated with cancer stage. Additional research exploring causality between social determinants and disease severity will help to reduce the likelihood of advanced disease and improve PCa outcomes.
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