Emory University/Atlanta Veterans' Affairs Medical Center
Introduction: Socioeconomic factors are associated with prostate cancer (PCa) disparities. This study aimed to identify the association between rurality and neighborhood deprivation on prostate cancer-specific mortality (PCSM) for men diagnosed and treated in Wisconsin. Methods: Wisconsin Cancer Reporting System (WCRS) data were used to identify all men diagnosed with PCa between 1995-2010. These data were merged with rural-urban commuting area (RUCA) codes to identify patients living in rural, small town, and urban areas. Deprivation was measured by the Area of Deprivation Index (ADI) at the census block group level using the Neighborhood Atlas®, a validated composite measure which allows for rankings of neighborhoods by socioeconomic disadvantage based on income, education, employment, and housing quality. ADIs were categorized into quartiles. Differences in baseline demographic and clinicopathologic characteristics were determined using chi-square tests. Cox proportional hazards models were used to estimate the effect of neighborhood archetype and deprivation on PCSM, adjusted for age, clinical grade, stage, diagnosis year +/- treatment. Results: 62,474 men with PCa were identified with a median follow up of 5.7 years (primary) and 9.6 years (sensitivity analyses). 41,885 men (67%) resided in urban areas, 7,102 (11%) in small towns and 13,487 (22%) in rural areas. Men living in rural areas were diagnosed at older ages and more commonly had nodal and metastatic disease (p <0.001). Among all three neighborhood archetypes, definitive treatment increased in later time periods with overall higher rates of surgery versus radiation. In small towns, radiation was more prevalent. In comparison to men living in urban areas, there was no increased risk of PCSM for men in rural or small town areas (p=0.09-0.56). Further, there was no difference in PCSM risk for advantaged men living in urban, rural or small town areas (p=0.39-0.93). Disadvantaged rural men had increased risk of PCSM compared to disadvantaged urban men (Q3: aHR = 1.2 (95% CI 1.0-1.35, p = 0.042). This trend was not observed in men residing in the most deprived neighborhoods (Q4: p=0.21-0.53). Conclusions: Men living in rural areas had more aggressive disease on presentation in comparison to men residing in small towns and urban areas, possibly reflecting differences in screening patterns. Overall, there was no difference in PCa-specific deaths by neighborhood archetype; however, differences in deprivation status within the archetypes underscore the association between lack of neighborhood-level resources and oncologic outcome. SOURCE OF Funding: Esdaille: AUA/UCF Research Scholar Award Grant# 017-822959
