Prostate cancer, race, and socioeconomic status: Inadequate adjustment for social factors in assessing racial differences

Abstract

BACKGROUND This paper reviews the state of the art in analyzing race, social factors, and economic factors in cancer research, with an emphasis on prostate cancer and the role of socioeconomic status (SES) in racial differences in mortality. It analyzes the quality of articles in the literature that assess the role of SES in cancer mortality. METHODS English‐language titles were identified using MEDLINE with publication dates from mid‐1985 through July 1994. Articles in the references of these articles were also included in the final selection, based originally on title and ultimately on content, dating back to 1978. Articles that included SES information and distinguished between whites and African‐Americans were chosen, resulting in a final selection of 21 articles. Articles are summarized with consideration of five criteria considered minimal requirements of a well‐designed study of the role of race in cancer mortality: (1) SES measure(s) should be on an individual level, not census level; (2) SES should be controlled for when making comparisons between whites and blacks; (3) SES should include at least (individual level) measures of income and education; (4) sample sizes are sufficient for the relevant populations; and (5) specific cancer sites should be studied separately. RESULTS Of the articles reviewed, only two meet the minimum standards, neither of which studied prostate cancer. It is not clear whether observed racial differences in prostate cancer are directly attributable to race or reflect underlying social factor differences between whites and African‐Americans. CONCLUSIONS In the future, specific characteristics of SES should be measured at the individual level; there is a need for expansion and standardization of data in terms of social and economic content; other methodological advances are needed in modeling to take into consideration the influence of SES in outcome research related to cancer. © 1996 Wiley‐Liss, Inc.

Exploratory analysis on the effect of race on clinical outcome in patients with advanced prostate cancer receiving bicalutamide or flutamide, each in combination with LHRH analogues

“…Socioeconomic status may also be an important factor in the development of prostate cancer, but further research is needed [28]. However, even when equal access to healthcare is taken into account [6,26] or adjustment is made for socioeconomic status [27], AA men in the US still have a poorer outcome than white men.…”

Effect of socioeconomic status as measured by education level on survival in breast cancer clinical trials

“…In spite of the numerous published papers that have specifically examined the relationship between SES and cancer survival, questions persist because of inconsistent conclusions . Possible explanations for this inconsistency include differences in the research question being asked (e.g., impact of SES on survival in the general population or impact in a clinical trial population), the patient population (e.g., homogeneous or heterogeneous histology or stage, as well as the national, racial, and ethnic composition), sample size or power considerations, the data source (e.g., census, regulatory, Surveillance, Epidemiology and End Results Program, clinical trial treatment trial, or patient reports), and the measure of SES (e.g., income, education, or occupation).…”

Changing face and different countenances of prostate cancer: Racial and geographic differences in prostate‐specific antigen (PSA), stage, and grade trends in the PSA era

“…This reinforces other results [14,24] suggesting that socioeconomic differences are largely responsible for the differences in disease presentation between whites and African-Americans. The composite results of the racialdifferences analyses of PSA, stage, and grade suggest that (1) previously reported racial differences were in fact due to socioeconomic differences [29][30][31], (2) these differences led to outcome differences, and (3) the increased use of PSA as a screening tool appears to ameliorate these differences. For the African-American population, these findings represent a good thing [9].…”