Association of Neighborhood Deprivation With Prostate Cancer and Immune Markers in African American and European American Men

Abstract

ImportanceNeighborhood variables may be factors in the excessive burden of prostate cancer among African American men.ObjectiveTo examine associations between neighborhood deprivation, circulating immune-oncology markers, and prostate cancer among African American and European American men.Design, Setting, and ParticipantsA case-control study was conducted between January 1, 2005, and January 1, 2016. Participants included men with prostate cancer and age- and race-frequency-matched population controls. Participants were recruited at the Baltimore Veterans Affairs Medical Center and University of Maryland Medical Center; controls were obtained through the Maryland Motor Vehicle Administration database. National Death Index follow-up was performed through December 31, 2020, and data analysis was conducted from February 1, 2022, through October 31, 2022.Exposures2000 Census-tract Neighborhood Deprivation Index as a standardized score.Main Outcomes and MeasuresPrimary outcomes included prostate cancer, all-cause mortality, and disease-specific mortality. Secondary outcomes included the National Comprehensive Cancer Network risk score and serum proteomes for 82 immune-oncology markers with pathway annotation.ResultsParticipants included men with prostate cancer (n = 769: 405 African American, 364 European American men) and age- and race-frequency-matched population controls (n = 1023: 479 African American, 544 European American men). The median survival follow-up was 9.70 years (IQR, 5.77 years), with 219 deaths. Among 884 African American men, mean (SD) age at recruitment was 63.8 (7.6) years; mean (SD) age at recruitment among 908 European American men was 66.4 (8.1) years. In the multivariable logistic regression analysis with individual socioeconomic status adjustment, neighborhood deprivation was associated with 55% increased odds of prostate cancer among African American men (odds ratio [OR], 1.55; 95% CI, 1.33-1.81), but was not associated with the disease among European American men. Residing in the most-deprived vs least-deprived neighborhoods corresponded to 88% higher disease odds (OR, 1.88; 95% CI, 1.30-2.75) among all men and an approximate 3-fold increase among African American men (OR, 3.58; 95% CI, 1.72-7.45), but no association was noted among European American men. In Cox proportional hazard regression analyses, socioeconomic status–adjusted neighborhood deprivation was associated with an increased all-cause mortality only among African American men (hazard ratio [HR], 1.28; 95% CI, 1.08-1.53), whereas it was associated with metastatic disease and a 50% increased hazard of a prostate cancer–specific death among all men (HR, 1.50; 95% CI, 1.07-2.09). In analyses restricted to controls, neighborhood deprivation was associated with increased activity scores of serum proteome-defined chemotaxis, inflammation, and tumor immunity suppression.Conclusions and RelevanceThe findings of this study suggest that deprived neighborhood residency may increase the risk of African American men for prostate cancer and a related mortality, potentially through its association with systemic immune function and inflammation.

Association of neighborhood gentrification with prostate cancer and immune markers in African American and European American men

“…Additional information on the study population, including serum protein measurement and derived biological process/pathways, functional annotation and biological process score system, classification of cases using NCCN risk scores, and West African ancestry estimation has been published elsewhere. 7 3 | RESULTS…”

“…1 Adverse neighborhood environments contribute to cancer inequities in part because they control access to health-promoting resources. [2][3][4][5][6][7][8] In addition, adverse social neighborhood conditions can directly or indirectly influence prostate cancer outcomes by inducing chronic stress-related biological responses, oxidative stress, and chronic inflammation. 2,7 Neighborhoods are rapidly changing and characterizing the effects that these changing environments, particularly neighborhood gentrification, may have on cancer disparities is of significance, and remains poorly understood.…”

“…13,14 Tied to gentrification-related neighborhood changes are resegregation and displacement of low-income residents who are healthy to move, 15,16 as well as displacement of health protective social networks, social capital, health promoting community institutions, and medical resources tailored for underserved groups. 12,14,17,18 Although studies of the neighborhood environment have provided evidence that neighborhood deprivation increases the risk of lethal prostate cancer, 7 the impacts of gentrification on prostate cancer outcomes is not well researched and understood. 6,17 Therefore, using a large case-control study of AA and European American (EA) men, we examined the association of gentrification between the Decennial Census 1990 and the 2006-2010 American Community Survey with prostate cancer, disease mortality, and systemic inflammation and immune function.…”

Neighborhood Deprivation and DNA Methylation and Expression of Cancer Genes in Breast Tumors

“…Neighborhood deprivation has historically been measured via a neighborhood deprivation index (NDI) to empirically summarize multiple census tract–level variables into a single standardized index for statistical analyses . We used an NDI adapted from Messer et al that has been described previously . Briefly, participant addresses were geocoded and linked to census tracts from the 2000 census using normalized data from the National Neighborhood Change Database produced by GeoLytics .…”

“…For this analysis, the NDI was operationalized as either a continuous score, dichotomized at the median (less than or equal to the median vs greater than the median) or as quartiles with cutoffs based on distribution among women without breast cancer in our cohort (n = 104) (eFigure 1 in Supplement 1). We followed previous studies using different categorizations to assess neighborhood deprivation …”