Abstract 14846: Rurality and Associated Cardiovascular Events and Mortality in Older Men With Prostate Cancer: Longitudinal SEER Medicare Analysis

Abstract

Introduction: The effect of rurality as a social determinant of health in cardiovascular events (CVE) in patients with prostate cancer (PC) is unknown. Methods: Using the Surveillance, Epidemiology, and End Results-Medicare linked database, we identified males ≥ 66 years old with a new primary diagnosis of PC between 2009 and 2017. We also identified those who were undergoing leuprolide androgen deprivation therapy (ADT). These patients were followed to identify a primary outcome of CVE that included heart failure (HF), atrial fibrillation (AF), acute myocardial infarction (AMI), peripheral artery disease (PAD), coronary artery disease (CAD), ischemic stroke (IS) and cardiovascular death. Adjusted Cox proportional hazards modeling was performed to estimate all-cause mortality in PC patients stratified by rurality as defined by Medicare. Adjusted Fine-Gray modeling with appropriate competing risk (mortality or type of mortality) was utilized for other outcomes as presented. We adjusted for demographic factors, social determinants of health, cancer-specific factors, and other cardiovascular risk factors apart from the primary exposure of rurality. Results: This study included 102,225 PC patients. Among these, 4,945 (4.8%) belonged to areas with a population of less than 2,500 or less than 20,000 not next to a metro (rural). The use of ADT was noted in 9,071 (8.9%) of patients. The incidence of new CVE and mortality risk due to rurality is presented in Table 1. Rural area was noted to be a risk factor for all-cause mortality [adjusted hazards ratio (aHR) = 1.114 (95% CI= 1.070-1.161)]. No statistically significant association between CVE and rurality, however, was observed in the data. Conclusions: PC patients have a high burden of pre-existing cardiovascular disease prior to PC diagnosis, and rurality increases all-cause mortality. This is consistent with those who are treated with ADT as well.