Prostate Cancer Incidence and Aggressiveness in Appalachia versus Non-Appalachia Populations in Pennsylvania by Urban-Rural Regions, 2004–2014

Abstract

Background: Few studies have examined prostate cancer incidence and aggressiveness in urbanrural Appalachian populations. We examined these rates in urban-rural Appalachia and non-Appalachia Pennsylvania (PA), and the association between these areas and more aggressive prostate cancer at diagnosis. Methods: Men, aged ≥ 40 years, with a primary prostate cancer diagnosis were identified from the 2004-2014 Pennsylvania Cancer Registry. Age-adjusted incidence rates for prostate cancer and more aggressive prostate cancer at diagnosis were calculated by urban-rural Appalachia status. Multivariable Poisson regressions were conducted. Multiple logistic regressions were used to examine the association between the geographical areas and more aggressive prostate cancer, after adjusting for confounders.Results: There were 94,274 cases, aged 40-105 years, included. Urban non-Appalachia had the highest 2004-2014 age-adjusted incidence rates of prostate cancer and more aggressive prostate cancer (293.56 and 96.39 per 100,000 men, respectively) and rural Appalachia had the lowest rates (256.48 and 80.18 per 100,000 men, respectively). Among the cases, urban Appalachia were more likely (OR=1.12; 95% CI=1.08-1.17) and rural Appalachia were less likely (OR= 0.92; 95% CI=0.87-0.97) to have more aggressive prostate cancer at diagnosis compared to urban non-Appalachia.Conclusions: Lower incidence rates and the proportion of aggressive disease in rural Appalachia may be due to lower prostate cancer screening rates. More aggressive prostate cancer at diagnosis among the cases in urban Appalachia may be due to exposures that are prevalent in the region.

Ambient air exposures to arsenic and cadmium and overall and prostate cancer–specific survival among prostate cancer cases in Pennsylvania, 2004 to 2014

“…1). In a previous study, we found PC cases who lived in urban Appalachia Pennsylvania were more likely to have aggressive PC at diagnosis compared to cases who reside in urban, non-Appalachia PA 18 ; however, in this study, we were unable to determine whether this association was because of environmental influences.…”

“…Patients diagnosed with distant metastasis were excluded. Demographic, clinical, and pathologic information from the PCR were extracted 17‐19 …”

“…Demographic, clinical, and pathologic information from the PCR were extracted. [17][18][19] Geographical region was defined by rurality and Appalachia status using the US Department of Agriculture's Rural-Urban Continuum Code 20 where counties coded with a Rural-Urban Continuum Code less than 4 21 and using the Appalachian Regional Commission definition, 22 respectively. There are 3 geographical strata by rurality and Appalachia status in Pennsylvania: rural Appalachia, urban Appalachia, and urban non-Appalachia (Fig.…”

Sociodemographic and Geographic Disparities of Prostate Cancer Treatment Delay in Tennessee: A Population-Based Study

“…Moreover, Appalachian Kentucky PCa patients had an increased probability of presenting advanced clinical cases, higher Gleason scores, higher PSA values, stage IV disease, and poorly differentiated tumor histology (Myint et al, 2019). Furthermore, McDonald et al (2020) reported that urban non-Appalachia Pennsylvania had the highest incidence rate of PCa and aggressive PCa compared to rural and urban Appalachian Pennsylvania. (2017) reported that US Appalachian areas may be experiencing increased PCa burden due to treatment delay, sometimes due to the rural or remote nature within the region.…”

Identifying Risk Profiles of Malignant Prostate Cancer Surgical Delay Using a Person-Centered Approach to Understand Prostate Cancer Disparities: The Constellation of Health Determinants Using Latent Class Analysis on Cancer Registry Data

“…Moreover, TD may present differently in Appalachian compared to non-Appalachian areas. A study by McDonald et al (2020) revealed that the highest incidence rate and aggressive type of PCa was found in non-Appalachian urban Pennsylvania compared to rural and urban Appalachian areas. Differential PCa outcomes within and between the Tennessee Appalachian and non-Appalachian regions while accounting for race are, however, limited.…”