MP21-10 THE VARIABLE IMPACT OF RACE AND MORE IMPORTANT FACTORS ON PROSTATE CANCER MORTALITY

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2018MP21-10 THE VARIABLE IMPACT OF RACE AND MORE IMPORTANT FACTORS ON PROSTATE CANCER MORTALITY Heidi Hanson, Christopher Martin, Brock O'Neil, Erik Mayer, Claire Leiser, and William Lowrance Heidi HansonHeidi Hanson More articles by this author , Christopher MartinChristopher Martin More articles by this author , Brock O'NeilBrock O'Neil More articles by this author , Erik MayerErik Mayer More articles by this author , Claire LeiserClaire Leiser More articles by this author , and William LowranceWilliam Lowrance More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.701AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES African American race has been linked to increased risk for prostate cancer mortality by both biological and epidemiologic mechanisms. Based on this information, many experts suggest African American race as an important prostate cancer risk factor, potentially exposing these men to variations in screening or treatment. However, some studies that adjust for access to care or other healthcare related variables have failed to find an increase in risk among African Americans. In our study, we intend to measure the relative impact of individual, disease specific, and county level factors on the risk of cancer specific mortality in men with prostate cancer. METHODS Using SEER data linked to the Area Health Resource File we identified men with prostate cancer diagnosed at age 60-79 between 2004-2012. For these patients we analyzed the affect of both individual and county level characteristics and their relative contribution to risk of prostate cancer specific mortality. Stage is based on information collected under the Collaborative Stage Data Collection System (CS) and coded using the CS algorithm. Tumor grade was based on gleason grading system. Patients with unknown clinical values were placed into a separate unknown category. RESULTS Figure 1 shows the variable importance measures. As expected, stage, Gleason score, and PSA are the most important predictors of prostate cancer survival. County level measures of the number of doctors, social vulnerability, and median family income are also important variables in predicting prostate cancer mortality. CONCLUSIONS The major determinants of mortality in prostate cancer were disease specific factors. Although African American race had a measurable impact, factors related to healthcare access and quality of care (factors known to be associated with African American race) had a stronger affect. Our results suggest the elevated risk identified in African Americans is largely driven by confounding factors associated with African American race. Thus, if factors other than biology or tumor characteristics underlie the elevations in risk found in African Americans, reducing the racial disparities in care rather than individualizing care based on race is more likely to improve prostate cancer outcomes. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e266 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Heidi Hanson More articles by this author Christopher Martin More articles by this author Brock O'Neil More articles by this author Erik Mayer More articles by this author Claire Leiser More articles by this author William Lowrance More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...