County-level racial disparities in prostate cancer specific mortality from 2005 to 2020.

IF 3.4 Q2 ONCOLOGY JNCI Cancer Spectrum Pub Date : 2024-11-04 DOI:10.1093/jncics/pkae109
Samuel L Washington, Mary Fakunle, Lufan Wang, Avery E Braun, Michael Leapman, Janet E Cowan, Matthew R Cooperberg
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Abstract

Background: Local conditions where people live continue to influence prostate cancer outcomes. By examining local characteristics associated with trends in Black-White differences in prostate cancer specific mortality (PCSM) over time, we aim to identify factors driving county-level PCSM disparities over a 15-year period.

Methods: We linked county-level data (Area Health Resource File) with clinicodemographic data of men with prostate cancer (Surveillance, Epidemiology, and End Results registry) from 2005 to 2020. Generalized linear mixed models evaluated associations between race and county-level age-standardized PCSM, adjusting for age, year of death, rurality, and county-level education, income, uninsured rates, and densities of urologists, radiologists, primary care providers, and hospital beds.

Results: 185,390 patients in 1085 counties were identified, of which 15.8% were non-Hispanic Black. Racial disparities in PCSM narrowed from 2005 to 2020 (25.4 per 100,000 to 19.2 per 100,000 overall; 57.9 per 100,000 to 38 per 100,000 for Non-Hispanic Black patients and 23.4 per 100,000 to 18.3 per 100,000 for Non-Hispanic White patients). For both Non-Hispanic Black and Non-Hispanic White patients, county PCSM changes varied greatly (-65% to + 77% and -61% to + 112%, respectively). From 2016 to 2020, Non-Hispanic Black harbored greater PCSM risk (RR 2.09, 95% CI 2.01-2.18); higher radiation oncologist density was significantly associated with lower mortality risk (RR 0.93, 95% CI 0.89-0.98) while other provider densities were not.

Conclusion: Although overall rates improved, specific counties experienced worsening race-based disparities over time. Identifying locations of highest (and lowest) mortality disparities remains critical to development of location-specific solutions to racial disparities in prostate cancer outcomes.

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2005 年至 2020 年前列腺癌特定死亡率的县级种族差异。
背景:人们生活的当地条件继续影响着前列腺癌的治疗效果。通过研究与黑人-白人前列腺癌特异性死亡率(PCSM)随时间变化的趋势相关的地方特征,我们旨在确定在 15 年间造成县级 PCSM 差异的因素:我们将 2005 年至 2020 年的县级数据(地区卫生资源档案)与前列腺癌男性患者的门诊人口学数据(监测、流行病学和最终结果登记)联系起来。广义线性混合模型评估了种族与县级年龄标准化 PCSM 之间的关系,并调整了年龄、死亡年份、乡村、县级教育、收入、无保险率以及泌尿科医生、放射科医生、初级保健提供者和医院床位的密度:结果:确定了 1085 个县的 185,390 名患者,其中 15.8% 为非西班牙裔黑人。从 2005 年到 2020 年,PCSM 的种族差异有所缩小(总体从每 10 万人 25.4 例降至每 10 万人 19.2 例;非西班牙裔黑人患者从每 10 万人 57.9 例降至每 10 万人 38 例;非西班牙裔白人患者从每 10 万人 23.4 例降至每 10 万人 18.3 例)。对于非西班牙裔黑人和非西班牙裔白人患者而言,县级 PCSM 变化差异很大(分别为 -65% 至 + 77% 和 -61% 至 + 112%)。从2016年到2020年,非西班牙裔黑人的PCSM风险更高(RR 2.09,95% CI 2.01-2.18);放射肿瘤学家密度越高,死亡率风险越低(RR 0.93,95% CI 0.89-0.98),而其他医疗机构密度则不然:结论:尽管总体死亡率有所提高,但随着时间的推移,特定县域的种族差异在不断恶化。确定死亡率差异最高(和最低)的地区对于制定针对特定地区的前列腺癌种族差异解决方案至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JNCI Cancer Spectrum
JNCI Cancer Spectrum Medicine-Oncology
CiteScore
7.70
自引率
0.00%
发文量
80
审稿时长
18 weeks
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