Abstract B098: Individual and contextual factors associated with prostate cancer stage at diagnosis: A multistate study
Authors: Adunlin Georges , Freeman Maisha K. , Galadima Hadiza I. , Asare Matthew 
Published: August 2020

Background: The success of prostate cancer (PCa) prevention and control programs should be measurable as a decrease in the likelihood of PCa diagnosis at a late stage in vulnerable and underserved populations.

Objective: To examine the relationship between individual socioeconomic status (SES), county-level measures of social determinants, and PCa stage at diagnosis.

Methods: Men aged 40 and older diagnosed with stage 0 to III PCa from 2000 to 2012 were identified from the Surveillance, Epidemiology, and End Results (SEER) tumor registries in 12 states. These states were retained because they had complete information on Federal Information Processing Standard (FIPS) county codes and across the study period. These data were combined with data from the Area Health Resource Files (AHRF). Stage at diagnosis was dichotomized as early stage (in situ, localized) versus late stage (regional, distant). Individual-level factors included age at diagnosis, race (white, black, others), ethnicity (Hispanic/Latino, non-Hispanic/Latino), marital status (married, unmarried), insurance status (insured, uninsured, unknown), tumor stage, tumor grade (undifferentiated, poorly differentiated, moderately differentiated, well differentiated), and year of diagnosis. Contextual-level factors included county level SES status, residence in rural/urban county, and county-level availability of health care resource. Student's t test for continuous variables and chi-square test for categorical variables were used for statistical comparisons. Hierarchical logistic regression models were used to identify factors associated with late-stage diagnosis.

Results: The sample consisted of N = 707,108 PCa cases of which 16.48 % (N = 116,511) are late stage and 16.48 % (N= 590,597) are early stage. The mean diagnosis age was 66 years old. The majority of these individuals were married (76%), White (80.76%), had unknown health insurance coverage (56.30%), were diagnosed in the year 2007 (8.56%), and lived in the state of California (38.48%). In the multivariate analysis, the odds of late-stage PCa diagnosis were higher in older men (odds ratio [OR] =1.013, 95% CI=1.012, 1.014), Blacks (OR=1.07, 95% CI=1.05, 1.09), and those with unknown insurance status (OR=1.12, 95% CI= 1.10, 1.15). County-level socioeconomic indicators including unemployment rates, educational attainment, poverty rates, rural/urban classification were not predictors of late-stage diagnosis. Furthermore, county-level contextual variables related to the availability and accessibility of health care providers and health services were not associated with late-stage diagnosis.

Conclusions: Community-based interventions designed to increase utilization of PCa testing should continue to target vulnerable and underserved populations especially Black, and uninsured/underinsured men. It is hope that these efforts will improve early detection and contribute to improve survival.

Citation Format: Georges Adunlin, Maisha K. Freeman, Hadiza I. Galadima, Matthew Asare. Individual and contextual factors associated with prostate cancer stage at diagnosis: A multistate study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B098.