Place matters: Identifying communities with unequal risk for prostate cancer.

Abstract

e17519 Background: The epidemiology of prostate cancer (CaP) in the US is influenced by patient demographics, community, and provider characteristics which vary geographically. We explore this variation using incidence rates (IR) to identify areas of highest risk and deconstruct the relative influence of community and provider characteristics in the state of North Carolina (NC). Methods: We examine age-adjusted IR data from the NC cancer registry and county-level data (number of primary care and urology physicians per capita, race, education/insurance/employment) from the Area Resource File to describe disease risk in NC. Spatial clustering analysis methods were applied to evaluate spatial autocorrelation and identify clusters with significant high (HH) and low (LL) incidence relative to the surrounding area. Analyses were used to compare defining characteristics between clusters. Results: The geographic distribution of CaP Incidence in NC is not random (p<.001). Local Indicator of Spatial Association (LISA) analysis identified 12 HH clusters and 11 LL clusters. The HH clusters had a significantly larger proportion of black residents, fewer urologists and primary care physicians per capita, and lower SES than LL clusters. Conclusions: This study suggests that county-level socioeconomic and racial variables, as well as access to primary and specialty care, are associated with geographic disparities in prostate cancer. These observations support additional work with spatial regression to further characterize factors affecting disparities in incidence and outcomes to better identify targets for intervention. Community characteristics (mean and standard deviation) by HH and LL clusters. Characteristics HH Clusters (N=12) LL Clusters (N=11) P-value from t-test Urologists per 100,000 (2005) 1.3 (1.8) 4.9 (4.3) 0.0239 Primary care doctors per 100,000 (2010) 43.0 (38.1) 61.4 (33.0) 0.2287 Percent people in poverty (2006) 20.7 (4.3) 16.0 (3.0) 0.0072 Percent black (2006) 45.5 (13.1) 8.2 (9.6) < 0.0001 Percent males without insurance (2006) 18.4 (2.5) 23.9 (2.2) < 0.0001 Percent of people with less than high school education (2005-2009) 23.7 (4.5) 18.7 (4.1) 0.0121 Unemployment rate (2006) 5.9 (0.9) 4.7 (0.9) 0.0036