Sociodemographic predictors of the late-stage diagnosis in patients with prostate cancer: A retrospective cohort study.
Authors: Khan Muhammad Ali , Afzal Muhammad Umar , Raina Ammad , Riaz Zaryab Bin , Warraich Kainat , Sartor Alton Oliver , Bryce Alan Haruo , Singh Parminder , Childs Daniel S , Orme Jacob , Abdul-Muhsin Haidar , Kase Adam McLain , Moore Cassandra N. , Agarwal Neeraj , Zakharia Yousef , Cobran Ewan Kemar , Riaz Irbaz Bin 
Published: February 2025

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Background:
Distant metastasis at the time of prostate cancer (PCa) diagnosis is associated with increased morbidity and mortality. This study aimed to assess the impact of sociodemographic characteristics on distant metastasis at the time of PCa diagnosis.
Methods:
The Surveillance Epidemiology and End Results (SEER) database (2000-2021), including PCa patients from 17 registries, was queried. Patients with late-stage diagnosis (LSD) were defined as those who were initially diagnosed with stage IV disease, indicating distant metastasis. Sociodemographic predictors included race, ethnicity, age, marital status, residential status, and median household income. Multicollinearity was assessed using variance inflation factors (VIF). Univariable logistic regression was performed to identify significant predictors of LSD, which were further analyzed in multivariable logistic regression using a maximum likelihood estimation approach. Odds ratios with 95% confidence intervals (CI) were computed with a p-value of <0.05 indicating a statistically significant association.
Results:
Of the 1,089,736 PCa patients diagnosed, 64,983 (6%) had an LSD. The majority were white (80%), non-Hispanic/Latino (HL) (91%), aged ≥65 years (60%), married (75%), residents in metropolitan areas (88%), and had an annual house income of ≥$70,000 (70%). Multivariable logistic regression identified Black (OR: 1.24; 95%CI: 1.22-1.27), Asian or Pacific Islander (1.35; 1.30-1.40), and American Indian/Alaska Native (1.70; 1.53-1.89) to have higher odds of LSD compared to White patients (Table). In addition, HL ethnicity compared to non-HL (OR: 1.45; 95% CI: 1.42-1.49), age ≥65 compared to <65 (1.68; 1.65-1.71), unmarried status compared to married (1.88; 1.85-1.91), residency in non-metropolitan areas compared to metropolitan (1.10; 1.07-1.12), and household income <$70,000 compared to ≥$70,000 (1.03; 1.01-1.05) had a significant association with LSD.
Conclusions:
Older, non-White (Black, Asian/Pacific Islander, American Indian/Alaska Native), Hispanic/Latino, unmarried men, residents of non-metropolitan areas, or those with lower annual household incomes have higher odds of late-stage diagnosis. Interventions targeting early detection in these at-risk groups may improve prostate cancer outcomes in the US.

Variable
Odds Ratio (95% CI)
p-value

Race (Black vs White)
1.24 (1.22-1.27)
<0.01

Race (Asian or Pacific Islander vs White)
1.35 (1.31-1.40)
<0.01

Race (American Indian/Alaska Native vs White)
1.70 (1.53-1.89)
<0.01

Ethnicity (Hispanic/Latino vs non-/Hispanic/Latino)
1.45 (1.42-1.49)
<0.01

Age (≥65 vs <65)
1.68 (1.65-1.71)
<0.01

Marital status (unmarried vs married)
1.88 (1.85-1.91)
<0.01

Residence status (non-metropolitan vs metropolitan)
1.10 (1.07-1.12)
<0.01

Household income (<$70,000 vs ≥$70,000)
1.03 (1.01-1.05)
<0.01