The effect of socioeconomic status, race, and insurance type on newly diagnosed metastatic prostate cancer in the United States (2004–2013)

Abstract

Background Understanding the characteristics of men who initially present with metastatic prostate cancer (mPCa) can better enable directed improvement initiatives. The objective of this study was to assess the relationship between socioeconomic status (SES) and newly diagnosed mPCa. Materials Methods All men diagnosed with PCa in the National Cancer Data Base from 2004 to 2013 were identified. Characteristics of men presenting with and without metastatic disease were compared. A 4-level composite metric of SES was created using Census-based income and education data. Multivariable logistic regression was used to evaluate the association between SES, race/ethnicity, and insurance and the risk of presenting with mPCa at the time of diagnosis. Results Of 1,034,754 patients diagnosed with PCa, 4% had mPCa at initial presentation. Lower SES (first vs. fourth quartile; odds ratio [OR] = 1.39, 95% CI: 1.35-1.44), black and Hispanic race/ethnicity (vs. white; OR = 1.47, 95% CI: 1.43-1.51 and OR = 1.22, 95% CI: 1.17-1.28, respectively), and having Medicaid or no insurance (vs. Medicare or private; OR = 3.91, 95% CI: 3.78-4.05) were each independently associated with higher odds of presenting with mPCa after adjusting for all other covariates. Conclusions Lower SES, race/ethnicity, and having Medicaid or no insurance were each independently associated with higher odds of presenting with metastases at the time of PCa diagnosis. Our findings may partially explain current PCa outcomes disparities and inform future efforts to reduce disparities.

Geographical Variations in Prostate Cancer Outcomes: A Systematic Review of International Evidence

“…There were some variations in the definition of advanced prostate cancer with three studies each basing their classification on tumor size (77, 78, 85) or prostate cancer risk groups (79, 86, 100) and one on pathological Gleason score (90). All remaining studies used a standard cancer staging system (such as the SEER Summary stage or TNM) with Stage I-II cancers consistently referred to as localized disease, Stage III as regional disease and distant/metastatic (Stage IV) cancers as advanced (18, 24, 25, 39, 58, 64, 84, 88, 92, 102), although some collectively categorized both regional and distant cancers as advanced disease (21, 41, 55, 80–83, 87, 89, 91, 93–99, 101).…”

Socioeconomic and Health Care Coverage Disparities in Children, Adolescents and Young Adults with Sarcoma

“…Racial, ethnic, and socioeconomic status (SES) disparities in cancer care are well-documented within the adult population. [8][9][10][11][12] Previous research also suggests that racial and ethnic differences exist regarding delays in presentation and outcomes for sarcomas in the pediatric population. [13][14][15] While differences in tumor biology may exist among certain ethnic groups 16,17 , social and cultural barriers also affect access to care and patient outcomes.…”

Prostate Cancer Screening Trends After United States Preventative Services Task Force Guidelines in an Underserved Population

“… 18 Additionally, those without insurance, AA and Hispanic populations, and lower socioeconomic status more often present at a more advanced stage. 19 While this may be due to a delay in diagnosis, there is some evidence that AA men may present with more aggressive disease as there is a higher rate of upgrading at the time of radical prostatectomy and higher rates of biochemical recurrence. 20 , 21 …”