A Multilevel Analysis of Socioeconomic Status and Prostate Cancer Risk

Abstract

PURPOSE-We investigated whether prostate cancer was associated with socioeconomic status (SES) at the individual level, area level, or a combination of both levels.METHODS-This population-based case-control study of prostate cancer in men aged 65 to 79 years was conducted between 2000 and 2002 in South Carolina. Complete interviews were available for 407 incident prostate cancer cases and 393 controls (with respective response rates of 61% and 64%). We used educational level to measure individual-level SES and a composite variable capturing income and education from 2000 Census data to measure area-level SES.RESULTS-After adjustment for race, age, geographic region, and prostate-specific antigen testing, men with some college were at reduced risk for prostate cancer (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.27-0.72), as were men in the highest quartile of area-level SES (OR, 0.52; 95% CI, 0.34-0.80). When assessing individual-level and area-level SES simultaneously and accounting for their nonindependence, the independent negative associations persisted and appeared to be more striking for men with a diagnosis of localized disease, rather than advanced disease. CONCLUSION-The independent effects of area-level and individual-level SES on prostate cancer risk seen in our study may help explain the conflicting results of previous studies conducted at both levels.

Cervical Cancer Survival by Socioeconomic Status, Race/Ethnicity, and Place of Residence in Texas, 1995–2001

“…23 The four indicator variables were summed to create the final SES composite variable based on an accepted measure of community-level SES. [25][26][27] Analysis of the individual components of the composite variable showed satisfactory internal consistency (Cronbach's alpha ϭ 0.71). Given that the percent difference ranged from negative to positive values (corresponding to median incomes lesser and greater than the median income for Texas), the final composite variable was brought to a positive distribution by adding the absolute value of the largest negative value to the entire distribution.…”

Making a link between childhood physical abuse and cancer

“…Previous research has demonstrated a relationship between adult SES and many of the leading cancer diagnoses. [33][34][35][36][37] The finding, however, that the relationship between childhood physical abuse and cancer remained significant after adjusting for adult SES, including income and education level, suggests that adult SES does not seem to significantly mediate the relationship. As this study was preliminary in nature, it did not include every possible risk factor that would be needed to fully investigate the potential causal pathways that might link childhood physical abuse and cancer.…”

“…32 Specifically, SES measured using education and/or income has been independently and inversely related with risk for prostate, 33 lung, [34][35][36] and colorectal cancer. 35,37 Incidence of cancers of the cervix, the head and neck region, and the gastrointestinal tract have also been found to be inversely proportional to SES.…”

Neighborhood deprivation and prostate cancer mortality: a multilevel analysis from Sweden

“…[10][11][12][13][14] However, only a few studies have documented the effects of neighborhood-level SES on prostate cancer risk. [15][16][17] To the best of our knowledge, no study to date has simultaneously analyzed the effect of neighborhood-level SES on prostate cancer mortality, after adjusting for individual-level characteristics.…”