Introduction: Prostate cancer (PCa) exhibits one of the widest racial and socioeconomic disparities. PCa disparities have also been widely linked to location, as living in more deprived regions was associated with lower healthcare access and worse outcomes. This study aims to examine PCa survival across various USA counties in function of different socioeconomic profiles and discuss the role of potential intermediary factors. Methods: The SEER database linked to county-level SES was utilized. Five-year PCa-specific survival using the Kaplan–Meier method was performed for five racial/ethnic categories in function of SES quintiles. Multilevel Cox proportional hazards regression was performed to assess the relationship between county-level SES and PCa survival. Multivariate regression analysis was performed to examine the role of healthcare utilization and severity. Results: A total of 239,613 PCa records were extracted, and 5-year PCa-specific survival was 94%. Overall, living in counties in the worst poverty/income quintile and the worst high-school level education increased PCa mortality by 38% and 33%, respectively, while the best bachelor’s-level education rates decreased mortality risk by 23%. Associations varied considerably upon racial/ethnic stratification. Multilevel analyses showed varying contributions of individual and area-level factors to survival within minorities. The relationship between SES and PCa survival appeared to be influenced by healthcare utilization and disease stage/grade. Discussion: Racial/ethnic categories responded differently under similar county-level SES and individual-level factors to the point where disparities reversed in Hispanic populations. The inclusion of healthcare utilization and severity factors may provide partial early support for their role as intermediaries. Healthcare access (insurance) might not necessarily be associated with better PCa survival through the performance of biopsy and or/surgery. County-level education plays an important role in PCa decision making as it might elucidate discussions of other non-invasive management options. Conclusions: The findings of this study demonstrate that interventions need to be tailored according to each group’s needs. This potentially informs the focus of public health efforts in terms of planning and prioritization. This study could also direct further research delving into pathways between area-level characteristics with PCa survival.
引言：前列腺癌（PCa）呈现出最为显著的种族和社会经济差异之一。前列腺癌的差异也广泛与地域相关，居住在更贫困地区往往与医疗资源获取不足及预后较差相关联。本研究旨在分析美国不同县区前列腺癌生存率与社会经济状况之间的关系，并探讨潜在中介因素的作用。 方法：研究采用与县级社会经济地位（SES）关联的SEER数据库。通过Kaplan-Meier法计算五个种族/族裔群体在不同SES五分位下的五年前列腺癌特异性生存率。采用多水平Cox比例风险回归评估县级SES与前列腺癌生存率的关系，并通过多元回归分析检验医疗资源利用和疾病严重程度的影响。 结果：共提取239,613例前列腺癌记录，五年前列腺癌特异性生存率为94%。总体而言，居住在贫困/收入最低五分位县区及高中教育水平最低县区的患者，其前列腺癌死亡率分别增加38%和33%；而学士学位教育水平最高县区可使死亡风险降低23%。不同种族/族裔分层显示关联性存在显著差异。多水平分析表明个体因素与区域因素对少数族裔生存率的影响程度各异。社会经济地位与前列腺癌生存率的关系似乎受到医疗资源利用和疾病分期/分级的影响。 讨论：不同种族/族裔群体在相同县级SES和个体因素条件下呈现差异化反应，西班牙裔人群甚至出现差异逆转现象。纳入医疗资源利用和疾病严重度因素可能为其中介作用提供初步支持。通过活检和/或手术实现的医疗可及性（保险覆盖）未必与更好的前列腺癌生存率直接相关。县级教育水平在前列腺癌决策中具有重要作用，可能促进其他非侵入性治疗方案的选择讨论。 结论：本研究结果表明干预措施需根据不同群体的需求进行针对性设计。这为公共卫生工作在规划与优先事项设定方面提供了参考依据。本研究还可引导后续深入探索区域特征与前列腺癌生存率之间的作用路径。
肿瘤(癌症)患者之家