Effect of Socioeconomic Factors on Long-term Mortality in Men With Clinically Localized Prostate Cancer

Published:January 23, 2009DOI:


      To examine the effect of socioeconomic factors on survival in black and white patients with local or regional prostate cancer.


      All cases (n = 2046) of clinically localized prostate cancer diagnosed from 1990 to 2000 at the Henry Ford Health System and the Henry Ford Medical Group, equal access health centers, were included. Data on the stage, grade, age at diagnosis, socioeconomic status, treatment given, comorbidities, and vital statistics were gathered from the Henry Ford Medical Group tumor registry and computerized databases, pathologic reports, patient charts, Surveillance, Epidemiology, and End Results database, and the national death registry. The endpoints were the overall and cancer-specific survival. Survival was calculated using Cox proportional hazards regression models.


      Of the 2046 cases, 1243 were white and 803 were black. Black patients were more likely to have lower incomes, a greater baseline prostate-specific antigen level, and greater comorbidities. They were also more likely to undergo radiotherapy and less likely to undergo radical prostatectomy. Univariate analysis, with white race as the baseline hazard, showed that black patients had significantly increased cancer-specific (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.01-2.13) and overall (HR 1.29, 95% CI 1.09-1.53) mortality. However, adjusting for insurance status and income on multivariate analysis revealed no significant differences in cancer-specific (HR 1.04, 95% CI 0.66-1.64) and overall (HR 0.96, 95% CI 0.78-1.18) survival.


      In this cohort, socioeconomic factors were sufficient to explain the disparity in survival between white and black patients. Survival differences disappeared after adjusting for income status on multivariate analysis.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jemal A.
        • Siegel R.
        • Ward E.
        • et al.
        Cancer statistics, 2007.
        Am Cancer Soc. 2007; 57: 43-66
        • Moul J.W.
        • Sesterhenn I.A.
        • Connelly R.R.
        • et al.
        Prostate-specific antigen values at the time of prostate cancer diagnosis in African-American men.
        JAMA. 1995; 274: 1277-1281
        • Ward E.
        • Jemal A.
        • Cokkinides V.
        • et al.
        Cancer disparities by race/ethnicity and socioeconomic status.
        CA Cancer J Clin. 2004; 54: 78-93
        • Godley P.A.
        • Schenck A.P.
        • Amamoo M.A.
        • et al.
        Racial differences in mortality among Medicare recipients after treatment for localized prostate cancer.
        J Natl Cancer Inst. 2003; 95: 1702-1710
        • Steenland K.
        • Rodriguez C.
        • Mondul A.
        • et al.
        Prostate cancer incidence and survival in relation to education (United States).
        Cancer Causes Control. 2004; 15: 939-945
        • Richardson J.T.
        • Webster J.D.
        • Fields N.J.
        Uncovering myths and transforming realities among low-SES African-American men: implications for reducing prostate cancer disparities.
        J Natl Med Assoc. 2004; 96: 1295-1302
        • Shavers V.L.
        • Brown M.L.
        Racial and ethnic disparities in the receipt of cancer treatment.
        J Natl Cancer Inst. 2002; 94: 334-357
        • Polednak A.P.
        Black-white differences in tumor grade (aggressiveness) at diagnosis of prostate cancer, 1992-1998.
        Ethn Dis. 2002; 12: 536-540
        • Cher M.L.
        • Lewis P.E.
        • Banerjee M.
        • et al.
        A similar pattern of chromosomal alterations in prostate cancers from African-Americans and Caucasian Americans.
        Clin Cancer Res. 1998; 4: 1273-1278
        • Deyo R.A.
        • Cherkin D.C.
        • Ciol M.A.
        Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases.
        J Clin Epidemiol. 1992; 45: 613-619
      1. SAS, version 8.
        SAS Institute, Inc, Cary, NC1999
        • Grossfeld G.D.
        • Latini D.M.
        • Downs T.
        • et al.
        Is ethnicity an independent predictor of prostate cancer recurrence after radical prostatectomy?.
        J Urol. 2002; 168: 2510-2515
        • Freedland S.J.
        • Amling C.L.
        • Dorey F.
        • et al.
        Race as an outcome predictor after radical prostatectomy: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.
        Urology. 2002; 60: 670-674
        • Moul J.W.
        • Connelly R.R.
        • Lubeck D.P.
        • et al.
        Predicting risk of prostate specific antigen recurrence after radical prostatectomy with the Center for Prostate Disease Research and Cancer of the prostate strategic Urologic research endeavor databases.
        J Urol. 2001; 166: 1322-1327
        • Cross C.K.
        • Shultz D.
        • Malkowicz S.B.
        • et al.
        Impact of race on prostate-specific antigen outcome after radical prostatectomy for clinically localized adenocarcinoma of the prostate.
        J Clin Oncol. 2002; 20: 2863-2868
        • Freedland S.J.
        • Jalkut M.
        • Dorey F.
        • et al.
        Race is not an independent predictor of biochemical recurrence after radical prostatectomy in an equal access medical center.
        Urology. 2000; 56: 87-91
        • Kang J.S.
        • Maygarden S.J.
        • Mohler J.L.
        • et al.
        Comparison of clinical and pathological features in African-American and Caucasian patients with localized prostate cancer.
        BJU Int. 2004; 93: 1207-1210
        • Optenberg S.A.
        • Thompson I.M.
        • Friedrichs P.
        • et al.
        Race, treatment, and long-term survival from prostate cancer in an equal access medical care delivery system.
        JAMA. 1995; 274: 1599-1605
        • Schapira M.M.
        • McAuliffe T.L.
        • Nattinger A.B.
        Treatment of localized prostate cancer in African-American compared with Caucasian men: less use of aggressive therapy for comparable disease.
        Med Care. 1995; 33: 1079-1088
        • Hoffman R.M.
        • Harlan L.C.
        • Klabunde C.N.
        • et al.
        Racial differences in initial treatment for clinically localized prostate cancer: results from the Prostate Cancer Outcomes Study.
        J Gen Intern Med. 2003; 18: 845-853
        • Shavers V.L.
        • Brown M.
        • Klabunde C.N.
        • et al.
        Race/ethnicity and the intensity of medical monitoring under “watchful waiting” for prostate cancer.
        Med Care. 2004; 42: 239-250
        • Bianco Jr, F.J.
        • Wood Jr, D.P.
        • Grignon D.J.
        • et al.
        Prostate cancer stage shift has eliminated the gap in disease-free survival in black and white American men after radical prostatectomy.
        J Urol. 2002; 168: 479-482
        • Wu H.
        • Sun L.
        • Moul J.W.
        • et al.
        Watchful waiting and factors predictive of secondary treatment of localized prostate cancer.
        J Urol. 2004; 171: 1111-1116
        • Dale W.
        • Vijayakumar S.
        • Lawlor E.F.
        • et al.
        Prostate cancer, race, and socioeconomic status: inadequate adjustment for social factors in assessing racial differences.
        Prostate. 1996; 29: 271-281
        • Krieger N.
        • Williams D.R.
        • Moss N.E.
        Measuring social class in US public health research: concepts, methodologies, and guidelines.
        Annu Rev Pub Health. 1997; 18: 341-348

      Linked Article

      • Erratum
        UrologyVol. 74Issue 1
        • Preview
          The article “Effect of Socioeconomic Factors on Long-term Mortality in Men With Clinically Localized Prostate Cancer” (Urology 2009;73(3):624-630)” was printed with errors in the author's name and percentage values in the second paragraph of result section. The corrections are shown in bold.
        • Full-Text
        • PDF