The Impact of Residential Segregation on Prostate Cancer Treatment and Outcomes
Samuel Helrich, BS, Michael Poulson, MD, Mark Katz, MD.
Boston University School of Medicine, Boston, MA, USA.
Introduction: There are well-documented disparities in black-white prostate cancer outcomes. Prior studies have suggested that race-associated genetic variances, screening guidelines, and treatment disparities may contribute to worse prostate cancer outcomes in black patients. We sought to examine the effects of racial residential segregation on the diagnosis, management, and outcomes of black prostate cancer patients.
Materials & Methods: We obtained data on patients with prostate cancer from the Surveillance, Epidemiology, and End Results (SEER) program between 2005 and 2015 and limited to black and white patients within the 100 most populous participating counties. County demographics and socioeconomic characteristics were obtained from the 2013 5-year estimates of the American Community Survey (ACS). The racial index of dissimilarity (IoD) was used to assess the evenness with which white and black residents are distributed across census blocks within each county. Multivariable analyses were performed, predicting advanced stage at diagnosis (AJCC stage IV) in the overall cohort, and the resection of localized disease (AJCC stage I-II).
Results: When adjusting for SEER region and age at diagnosis, black patients have a 98% increased risk (RR 1.98, 95% CI 1.41, 2.76) of presenting at advanced stage with increasing segregation. White patients comparatively have a 42% decreased risk (RR 0.58, 95% CI 0.48,0.70) of presenting at advanced stage with increasing segregation. When evaluating surgery for stage I and II cancers, black patients have a 26% decreased risk (RR 0.74, 95% CI 0.64, 0.86) of surgical resection with increasing segregation, while white patients have a 20% increased risk (RR 1.20, 95% CI 1.12, 1.29).
Conclusion: Our data suggest that residential segregation has a significant impact on both black and white patients with prostate cancer. Black patients fare worse in higher levels of segregation with higher stage at diagnosis and lower likelihood of surgical resection, while white patients benefit from higher segregation with lower stage at diagnosis and higher likelihood of surgical resection. These findings underpin the importance of targeting structural racism and residential segregation when addressing black-white prostate cancer disparities.
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