Socioeconomic status, healthcare density, and risk of prostate cancer among African American and Caucasian men in a large prospective study.
ABSTRACT The purpose of this study was to separately examine the impact of neighborhood socioeconomic deprivation and availability of healthcare resources on prostate cancer risk among African American and Caucasian men.
In the large, prospective NIH-AARP Diet and Health Study, we analyzed baseline (1995-1996) data from adult men, aged 50-71 years. Incident prostate cancer cases (n = 22,523; 1,089 among African Americans) were identified through December 2006. Lifestyle and health risk information was ascertained by questionnaires administered at baseline. Area-level socioeconomic indicators were ascertained by linkage to the US Census and the Area Resource File. Multilevel Cox models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).
A differential effect among African Americans and Caucasians was observed for neighborhood deprivation (p-interaction = 0.04), percent uninsured (p-interaction = 0.02), and urologist density (p-interaction = 0.01). Compared to men living in counties with the highest density of urologists, those with fewer had a substantially increased risk of developing advanced prostate cancer (HR = 2.68, 95 % CI = 1.31, 5.47) among African American.
Certain socioeconomic indicators were associated with an increased risk of prostate cancer among African American men compared to Caucasians. Minimizing differences in healthcare availability may be a potentially important pathway to minimizing disparities in prostate cancer risk.
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ABSTRACT: In 1995-1996, the authors mailed a food frequency questionnaire to 3.5 million American Association of Retired Persons members who were aged 50-69 years and who resided in one of six states or two metropolitan areas with high-quality cancer registries. In establishing a cohort of 567,169 persons (340,148 men and 227,021 women), the authors were fortunate in that a less-than-anticipated baseline response rate (threatening inadequate numbers of respondents in the intake extremes) was offset by both a shifting and a widening of the intake distributions among those who provided satisfactory data. Reported median intakes for the first and fifth intake quintiles, respectively, were 20.4 and 40.1 (men) and 20.1 and 40.0 (women) percent calories from fat, 10.3 and 32.0 (men) and 8.7 and 28.7 (women) g per day of dietary fiber, 3.1 and 11.6 (men) and 2.8 and 11.3 (women) servings per day of fruits and vegetables, and 20.7 and 156.8 (men) and 10.5 and 97.0 (women) g per day of red meat. After 5 years of follow-up, the cohort is expected to yield nearly 4,000 breast cancers, more than 10,000 prostate cancers, more than 4,000 colorectal cancers, and more than 900 pancreatic cancers. The large size and wide intake range of the cohort will provide ample power for examining a number of important diet and cancer hypotheses.American Journal of Epidemiology 01/2002; 154(12):1119-25. · 4.78 Impact Factor
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ABSTRACT: We examined demographic, behavioral, psychosocial, and dietary correlates of prostate, breast, and colorectal cancer screening in a population-based sample of African Americans in North Carolina (n=405). Cross-sectional data of African Americans in North Carolina were analyzed using linear regression models. Seventy-eight percent of men had obtained prostate screening (PSA test) and 81% of women had received breast cancer screening (mammogram) during the previous two years. Screening rates for CRC were lower (48% women, 31% men in the previous ten years). Older age, college education, and being married were associated with all screening modalities, as was belief in a diet-cancer relationship with PSA testing and mammography. There were correlations of former smoking, obesity, and healthy eating self-efficacy with PSA testing, and family/personal cancer history with CRC screening. Screening for all cancers was associated with lower fat consumption, and PSA testing with high fruit/vegetable intake (p<.05). Cancer screening was prevalent, but rates did not approach national targets. Knowledge of these correlates can be used to design effective cancer screening interventions for African Americans.Journal of Health Care for the Poor and Underserved 12/2007; 18(4 Suppl):146-64. · 1.10 Impact Factor
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ABSTRACT: We hypothesized that prostate cancer screening and availability of urologists among states may be associated with reduced prostate cancer mortality in the United States. To test this hypothesis, state-specific prostate cancer mortality rates for white males were compared to urologist population densities and prostate-specific antigen (PSA) screening rates on a state-by-state basis. The urologist population density was calculated by dividing the number of urologists per state by the population. We found that prostate cancer mortality rates correlated inversely with urologist population densities (P<0.01) and PSA screening (P<0.01) suggesting that screening and treatment reduce prostate cancer mortality.Prostate cancer and prostatic diseases 02/2008; 11(3):247-51. · 2.10 Impact Factor