Objectives
To examine the effect of socioeconomic factors on survival in black and white patients
with local or regional prostate cancer.
Methods
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.
Results
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.
Conclusions
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.
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Article info
Publication history
Published online: January 23, 2009
Accepted:
September 4,
2008
Received:
May 1,
2008
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
