Persistent Poverty and Its Interaction With Race: Their Influence on Prostate Cancer-Specific Mortality

Prostate cancer mortality is shaped by both racial and socioeconomic disparities, yet the combined effect of long-term economic hardship and race remains underexplored.

To investigate the association between persistent poverty and race on prostate cancer-specific mortality in U.S. counties.

We analyzed age-adjusted prostate cancer mortality rates from the Surveillance, Epidemiology, and End Results (SEER) program (1999-2020) and linked them to U.S. Department of Agriculture county-level persistent poverty classifications. Persistent poverty was defined as ≥ 20% of residents living in poverty across the past 30 years. Quantile regression at the 25th percentile was used to address data skewness, adjusting for region, urban status, and year. Interaction terms between persistent poverty and race, as well as a 3-way interaction (poverty × race × year), were included to assess whether racial disparities changed over time.

Data from 3119 counties were examined, including 318 persistent poverty counties. County-level persistent poverty was associated with significantly higher prostate cancer mortality rates (β = 0.30; 95% CI, 0.06-0.54; P = .016). Black men had significantly higher mortality rates than White men at the county level (β = 8.10; 95% CI, 7.82-8.38; P < .001). The interaction between persistent poverty and race was significant (P < .001), with an excess Black versus White mortality rate of 10.9 versus 7.9 per 100,000 in persistent poverty counties versus nonpersistent poverty counties, respectively. Although mortality decreased for all groups from 1999 to 2020, the 3-way interaction term (poverty × race × year) was not significant (P > .7), indicating persistent race-specific mortality differences over time.

Persistent poverty is associated with higher prostate cancer-specific mortality rates and exacerbated racial differences. Despite overall mortality declines, the racial mortality gap remained consistently larger in counties affected by persistent poverty, underscoring the enduring impact of structural socioeconomic and racial inequities on prostate cancer outcomes at the population level.