Skip to main content
SpringerLink
Log in

Socioeconomic status, healthcare density, and risk of prostate cancer among African American and Caucasian men in a large prospective study

  • Original Paper
  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this study was to separately examine the impact of neighborhood socioeconomic deprivation and availability of healthcare resources on prostate cancer risk among African American and Caucasian men.

Methods

In the large, prospective NIH-AARP Diet and Health Study, we analyzed baseline (1995–1996) data from adult men, aged 50–71 years. Incident prostate cancer cases (n = 22,523; 1,089 among African Americans) were identified through December 2006. Lifestyle and health risk information was ascertained by questionnaires administered at baseline. Area-level socioeconomic indicators were ascertained by linkage to the US Census and the Area Resource File. Multilevel Cox models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).

Results

A differential effect among African Americans and Caucasians was observed for neighborhood deprivation (p-interaction = 0.04), percent uninsured (p-interaction = 0.02), and urologist density (p-interaction = 0.01). Compared to men living in counties with the highest density of urologists, those with fewer had a substantially increased risk of developing advanced prostate cancer (HR = 2.68, 95 % CI = 1.31, 5.47) among African American.

Conclusions

Certain socioeconomic indicators were associated with an increased risk of prostate cancer among African American men compared to Caucasians. Minimizing differences in healthcare availability may be a potentially important pathway to minimizing disparities in prostate cancer risk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics. CA Cancer J Clin 60:277–300

    Google Scholar 

  2. Brawley OW, Jani AB, Master V (2007) Prostate cancer and race. Curr Probl Cancer 31:211–225

    Google Scholar 

  3. The Unequal Burden of Cancer (1999) An Assessment of NIH Research and Programs for Ethnic Minorities and the Medically Underserved. National Academy of Sciences, Washington, DC

    Google Scholar 

  4. Devesa S, Grauman D, Blot W, Pennello G, Hoover R, Fraumeni J (1999) Atlas of cancer mortality in the United States, 1950–94. National Institutes of Health, National Cancer Institute, Bethesda

  5. Resnick MJ, Canter DJ, Guzzo TJ, Brucker BM, Bergey M, Sonnad SS et al (2009) Does race affect postoperative outcomes in patients with low-risk prostate cancer who undergo radical prostatectomy? Urology 73:620–623

    Google Scholar 

  6. Robbins AS, Yin D, Parikh-Patel A (2007) Differences in prognostic factors and survival among White men and Black men with prostate cancer, California, 1995-2004. Am J Epidemiol 166:71–78

    Google Scholar 

  7. Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W et al (2010) SEER Cancer Statistics Review, 1975–2008. National Cancer Institute, Bethesda

  8. Gilligan T (2005) Social disparities and prostate cancer: mapping the gaps in our knowledge. Cancer Causes Control 16(1):45–53

    Article  PubMed  Google Scholar 

  9. Satia JA, Galanko JA (2007) Demographic, behavioral, psychosocial, and dietary correlates of cancer screening in African Americans. J Health Care Poor Underserved 18(4 Suppl):146–164

    Article  PubMed  Google Scholar 

  10. Jones NR, Williamson A, Foote M, Creswell PD, Strickland R, Remington P et al (2010) Cancer health disparities persist among African Americans in Wisconsin. WMJ 109(5):267–273

    PubMed  Google Scholar 

  11. Oliver MN, Smith E, Siadaty M, Hauck FR, Pickle LW (2006) Spatial analysis of prostate cancer incidence and race in Virginia, 1990–1999. Am J Prev Med 30:S67–76

    Google Scholar 

  12. Blankart CR (2012) Does healthcare infrastructure have an impact on delay in diagnosis and survival? Health Policy 105(2–3):128–137

    Article  PubMed  Google Scholar 

  13. Ananthakrishnan AN, Hoffmann RG, Saeian K (2010) Higher physician density is associated with lower incidence of late-stage colorectal cancer. J Gen Intern Med 25(11):1164–1171

    Article  PubMed  Google Scholar 

  14. Schatzkin A, Subar AF, Thompson FE, Harlan LC, Tangrea J, Hollenbeck AR et al (2001) Design and serendipity in establishing a large cohort with wide dietary intake distributions : the National Institutes of Health-American Association of Retired Persons Diet and Health Study. Am J Epidemiol 154(12):1119–1125

    Article  PubMed  CAS  Google Scholar 

  15. Willett W (1998) Nutritional epidemiology, 2nd edn. Oxford University Press, New York

    Book  Google Scholar 

  16. Michaud D, Midthune D, Hermansen S, Leitzmann M, Harlan L, Kipnis V et al (2005) Comparison of cancer registry case ascertainment with SEER estimates and self-reporting in a subset of the NIH-AARP Diet and Health Study. J Regist Manag 32:70–77

    Google Scholar 

  17. American Joint Committee on Cancer (1997) Manual for staging of cancer, 5th edn. Lippincott-Raven, Philadelphia

    Google Scholar 

  18. Willett WC, Howe GR, Kushi LH (1997) Adjustment for total energy intake in epidemiologic studies. Am J Clin Nutr 65(4 Suppl):1220S–1228S (discussion 1229S-1231S)

    Google Scholar 

  19. Major JM, Doubeni CA, Freedman ND, Park Y, Lian M, Hollenbeck AR et al (2010) Neighborhood socioeconomic deprivation and mortality: NIH-AARP diet and health study. PLoS One 5(11):e15538

    Article  PubMed  Google Scholar 

  20. Messer LC, Laraia BA, Kaufman JS, Eyster J, Holzman C, Culhane J et al (2006) The development of a standardized neighborhood deprivation index. J Urban Health 83(6):1041–1062

    Article  PubMed  Google Scholar 

  21. Fedewa SA, Etzioni R, Flanders WD, Jemal A, Ward EM (2010) Association of insurance and race/ethnicity with disease severity among men diagnosed with prostate cancer, National Cancer Database 2004–2006. Cancer Epidemiol Biomarkers Prev 19:2437–2444

    Google Scholar 

  22. Zeigler-Johnson CM, Tierney A, Rebbeck TR, Rundle A (2011) Prostate cancer severity associations with neighborhood deprivation. Prostate Cancer 2011:846263

    Article  PubMed  Google Scholar 

  23. Odisho AY, Fradet V, Cooperberg MR, Ahmad AE, Carroll PR (2009) Geographic distribution of urologists throughout the United States using a county level approach. J Urol 181:760–765 (discussion 765–766)

    Google Scholar 

  24. Holmes JA, Carpenter WR, Wu Y, Hendrix LH, Peacock S, Massing M et al (2012) Impact of Distance to a Urologist on Early Diagnosis of Prostate Cancer Among Black and White Patients. J Urol 187(3):883–888

    Google Scholar 

  25. Patel K, Kenerson D, Wang H, Brown B, Pinkerton H, Burress M et al (2010) Factors influencing prostate cancer screening in low-income African Americans in Tennessee. J Health Care Poor Underserved 21(1 Suppl):114–126

    Article  PubMed  Google Scholar 

  26. Colli JL, Amling CL (2008) Prostate cancer mortality rates compared to urologist population densities and prostate-specific antigen screening levels on a state-by-state basis in the United States of America. Prostate Cancer Prostatic Dis 11(3):247–251

    Article  PubMed  CAS  Google Scholar 

  27. Woods VD, Montgomery SB, Herring RP, Gardner RW, Stokols D (2006) Social ecological predictors of prostate-specific antigen blood test and digital rectal examination in black American men. J Natl Med Assoc 98(4):492–504

    PubMed  Google Scholar 

Download references

Acknowledgments

We are indebted to the participants in the NIH-AARP Diet and Health Study for their outstanding cooperation. We also thank Sigurd Hermansen and Kerry Grace Morrissey from Westat for study outcomes ascertainment and management and Leslie Carroll at Information Management Services for data support. This research was supported [in part] by the Intramural Research Program of the NIH, National Cancer Institute.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, 6120 Executive Boulevard, Bethesda, MD, 20852, USA

    Jacqueline M. Major, Barry I. Graubard & Rashmi Sinha

  2. Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA

    M. Norman Oliver

  3. Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, 01655, USA

    Chyke A. Doubeni

  4. AARP, Washington, DC, 20049, USA

    Albert R. Hollenbeck

Authors
  1. Jacqueline M. Major
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Norman Oliver
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chyke A. Doubeni
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Albert R. Hollenbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Barry I. Graubard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rashmi Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacqueline M. Major.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 55 kb)

Supplementary material 2 (DOC 45 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Major, J.M., Norman Oliver, M., Doubeni, C.A. et al. Socioeconomic status, healthcare density, and risk of prostate cancer among African American and Caucasian men in a large prospective study. Cancer Causes Control 23, 1185–1191 (2012). https://doi.org/10.1007/s10552-012-9988-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-012-9988-8

Keywords

Search

Navigation