Racial disparities in prostate cancer mortality: a model-based decomposition of contributing factors

Area of Science:

• Oncology
• Health Disparities Research
• Epidemiology

Background:

• Prostate cancer mortality shows significant racial disparities in the United States.
• Understanding the drivers of these disparities is essential for developing targeted interventions.

Purpose of the Study:

• To quantify the contributions of natural history and clinical interventions to racial disparities in prostate cancer mortality.
• To identify key factors influencing prostate cancer outcomes in Black men compared to the general population.

Main Methods:

• Extended a mathematical model previously calibrated with Surveillance, Epidemiology, and End Results (SEER) data.
• Integrated SEER data on treatment frequencies and cancer-specific survival.
• Projected age-standardized mortality rates by systematically replacing model components with data specific to Black men.

Main Results:

• Increased disease incidence, more aggressive tumor features, and worse cancer-specific survival in Black men at local-regional and distant stages were key contributors to mortality disparities.
• These factors explained 38%, 34%, and 22% of the modeled disparity, respectively.
• Worse survival at distant stages accounted for an additional 8% of the disparity.

Conclusions:

• Natural history factors, including disease aggressiveness and survival rates, play a substantial role in racial disparities in prostate cancer mortality.
• Clinical interventions and intensified screening for Black men are identified as priority areas to reduce mortality gaps and promote health equity.