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Geographic Distribution of Racial Differences in Prostate Cancer Mortality.

Sean A Fletcher1,2,3, Maya Marchese1,2, Alexander P Cole1,2

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Summary
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Racial disparities in prostate cancer mortality are geographically concentrated in specific US regions, particularly for low-risk cases. Targeted interventions in these areas could reduce prostate cancer survival gaps between Black and White men.

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Area of Science:

  • Oncology
  • Epidemiology
  • Health Disparities

Background:

  • Racial disparities in prostate cancer mortality are well-documented in the United States.
  • Geographic variations in these disparities are not well understood.

Purpose of the Study:

  • To characterize geographic variations in prostate cancer-specific mortality differences between Black and White men.
  • To identify specific regions with significant survival disparities.

Main Methods:

  • A cohort study utilized data from 17 geographic registries within the Surveillance, Epidemiology, and End Results (SEER) database (2007-2014).
  • Fine and Gray competing-risks regression analyses were performed to assess prostate cancer-specific mortality differences between racial groups.
  • Stratified analyses were conducted by Gleason grade group (1 and 2-5).

Main Results:

  • The study included 229,771 men, with Black men exhibiting a higher overall risk of prostate cancer mortality compared to White men (AHR, 1.39).
  • Significant geographic variations in survival disparities were observed, with four registries showing worse outcomes for Black men in both low-risk (Gleason grade group 1) and higher-risk (Gleason grade groups 2-5) disease.
  • The Atlanta registry demonstrated the greatest race-based survival difference for men with Gleason grade group 1 prostate cancer.

Conclusions:

  • Population-level prostate cancer survival differences between Black and White men are concentrated in specific geographic areas and are associated with low-risk disease.
  • Targeted interventions in identified high-disparity regions may effectively mitigate national prostate cancer care disparities.