Socioeconomic factors major players in prostate cancer racial disparity
medwireNews: Research published in JAMA Oncology confirms that prostate cancer-specific mortality (PCSM) is not significantly different between Black and White men with nonmetastatic disease when access to care and treatment is comparable.
This study “adds to the growing body of evidence that race-defining biological differences do not explain prostate cancer health inequalities,” and provides “powerful evidence that equal treatment yields equal outcome among equal patients,” say the authors of an accompanying commentary.
Otis Brawley (Johns Hopkins University, Baltimore, Maryland, USA) and colleagues add: “Although it is still true that men of African origin have a higher incidence of prostate cancer and higher mortality rates, the causes of these differences are complex and may involve exposure to prostate cancer risk factors, genomic differences, and other biology-based factors.
“Research to determine the relative contributions of these factors should continue; but in the meantime, we as health care professionals are likely to have the greatest effect on improved outcomes for African American patients with prostate cancer by ensuring that they get the same care as white patients, not just in clinical trials but throughout the national health care system.”
The study authors used data on 306,099 men with clinical T1–4N0–1M0 disease, of whom 296,273 were included in the US population-based SEER database, 3972 were from the Veterans Affairs (VA) cohort comprising patients treated at five equal-access regional medical centers, and 5854 were participants of four Radiation Therapy Oncology Group phase III randomized controlled trials (RCTs). The respective proportion of Black patients in each of these cohorts was 17.8%, 38.1%, and 19.3%.
In the SEER cohort, Black race was associated with an increased risk for PCSM in an inverse probability weighted propensity model adjusted for age, with a subdistribution hazard ratio (sHR) of 1.30 relative to White race. The risk was attenuated in the fully adjusted model accounting for a raft of socioeconomic and clinical factors, at a sHR of 1.09 at 10 years after diagnosis, but it remained significant.
By contrast, there was no increase in the risk for PCSM in either the VA or RCT cohort, with or without propensity adjustment. If anything, Black men appeared to have a lower PCSM risk than White men in the VA (sHR=0.85) and RCT (sHR=0.81) cohorts in the fully adjusted model, with the association reaching statistical significance in the latter.
Investigator Daniel Spratt, from the University of Michigan in Ann Arbor, USA, and collaborators highlight that Black race was significantly associated with “multiple socioeconomic barriers to quality care,” such as lower rates of non-Medicaid insurance and curative local therapies.
Therefore, they stress that “[c]ontinued efforts are needed to address this clear racial health inequity driven by modifiable nonbiological risk factors.”
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