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Rural-Urban Differences and Socioeconomic Disparities in Long-Term Urinary Adverse Events Following Prostate Cancer

Marvin N Carlisle1, Kevin D Li1,2, Stephanie L Jarosek3

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Men in rural areas had fewer long-term urinary adverse events (UAEs) after prostate cancer (PCa) treatment. However, racial and socioeconomic disparities in UAE risk persist.

Keywords:
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Area of Science:

  • Urology
  • Oncology
  • Health Services Research

Background:

  • Long-term urinary adverse events (UAEs) significantly impact prostate cancer (PCa) survivors' quality of life.
  • Existing research indicates geographic and sociodemographic disparities in PCa outcomes, but a detailed analysis of treatment-related UAEs is absent.

Purpose of the Study:

  • To investigate the association between rural vs. urban residence and the risk of long-term UAEs following PCa treatment.
  • To identify demographic and socioeconomic factors contributing to disparities in UAE risk among PCa patients.

Main Methods:

  • Retrospective cohort study using SEER-Medicare data (1999-2019) of men aged 66+ with nonmetastatic PCa.
  • Rural vs. urban residence classified using Rural-Urban Continuum Codes.
  • Multivariable Cox models and competing risks regression analyzed UAE risk, adjusting for covariates.

Main Results:

  • Rural residents (16% of cohort) had lower 15-year cumulative UAE incidence (17%) compared to urban residents (20%).
  • Rural residence was associated with reduced UAE rates (adjusted HR 0.90).
  • Higher UAE risk observed in Hispanic, non-Hispanic Black, less educated, and older patients (80+ years).

Conclusions:

  • Unexpectedly, rural residence correlated with lower UAE rates post-PCa treatment.
  • Significant disparities in UAE risk persist across racial and socioeconomic lines.
  • Complex interplay between geography, demographics, and treatment outcomes influences PCa survivors' urinary health.