Background. Prostate cancer is the most common non-cutaneous cancer and the second leading cause of death among men in the United States. It highlights one of the highest racial disparities in health outcomes across cancers, with Non-Hispanic Black (NHB) men being at a 1.6 times higher risk of being diagnosed and 2.5 times higher risk of dying from the disease compared to Non-Hispanic White (NHW). Stage at diagnosis is the major metric used for prostate cancer prognosis, and assesses the extent of the disease. Prostate cancer development and progression is a multifactorial phenomenon, influenced by factors ranging from biological interactions to nativity. Therefore, we aimed at describing the characteristics of prostate cancer cases in New York State, and conduct an exploratory analysis to determine among the factors commonly associated with prostate cancer development and progression, which sociodemographic determinants contributed to racial disparities in stage at diagnosis of prostate cancer in New York State. To do this, we accessed the New York State Cancer Registry (NYSCR).
Methods. Prostate cancer cases recorded in the NYSCR from 2004 to 2014 constituted our sample. The NYSCR report prostate cancer stage in both the American Joint Committee on Cancer (AJCC) Tumor Node Metastasis (TNM) classification system and the National Cancer Institute Surveillance Epidemiology and End Results Program (SEER) summary staging 2000. For this study, the SEER Program summary staging 2000 was used. We created mutually exclusive categories for each covariate (grade at diagnosis, race, age at diagnosis, insurance status, marital status and nativity), while accounting for the sociodemographic landscape of New York State. Descriptive statistics, univariate and multivariable logistic regression models were computed, adjusting for grade at diagnosis, race, age at diagnosis, insurance status, marital status, and nativity. The variables found to have more than 10% missing data were removed and the data reanalyzed, to see the influence of data quality on our results. The Hosmer-Lemeshow test was used to assess the goodness of fit of each model.
Results. The sample consisted of 164,765 cases with a mean age of 66.72 ± 9.79 years. The greatest proportion of cases was diagnosed as local or regional stage prostate cancer. Statistically significant associations with stage at diagnosis in both the adjusted and unadjusted models were found with grades 3 and 4, NHB, Hispanics, patients aged 65-74, 75-84 and more than 85 years old, Medicaid and Medicare insured patients, patients with no insurance, patients with unspecified/other insurance, patients not married, patients with unknown marital status and patients of whom nativity status was unknown. The association between insurance status and distant stage at diagnosis was statistically significant for patients with military insurance in the unadjusted model, but not after adjustment. Birthplace information was missing for 42.53% of our sample. After birthplace was removed from the model and the data reanalyzed, the association for military insurance became statistically significant, while the association for unknown marital status became non-statistically significant.
Conclusion. Within this population-based sample of New York State prostate cancer cases, stage at diagnosis was found to be associated with grade, race, age at diagnosis, insurance status, and marital status. The multiplicity of factors associated with distant stage at diagnosis confirms the multifactorial nature of disparities in prostate cancer outcomes. The high percentage of missing data precluded the accurate assessment of the role of nativity. However, the factors identified here to act on racial disparities in stage at diagnosis in New York State provide a solid foundation for future analysis.
|Commitee:||BOSCOE, FRANCIS P., TENNISWOOD, MARTIN|
|School:||State University of New York at Albany|
|School Location:||United States -- New York|
|Source:||MAI 56/05M(E), Masters Abstracts International|
|Keywords:||New York State, Prostate cancer, Racial disparities, Socio-demographic determinants, Stage at diagnosis|
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