Abstract B080: Examining racial differences in area-level factors associated with prostate cancer stage at diagnosis: A systematic review
Authors: Chukwudozie Ifeanyi B. , Martell Elle R. , Kaur Ravneet , Hanneke Rosie , Freeman Vincent 
Published: December 2023

In the United States, prostate cancer is the most diagnosed cancer and the second highest cause of cancer deaths in men. Despite the high survival rate for prostate cancer compared to other cancers, racial and ethnic disparities persist. Black males are more likely to be diagnosed at an advanced stage, with more aggressive forms, and have two-fold higher age-adjusted mortality rates than non-Hispanic White males. Research studies show that the stage at diagnosis is a critical prognostic factor for survival and access to quality health care. There is increasing evidence of an association between neighborhood area-level contextual factors (e.g., social and physical environments) and prostate cancer stage at diagnosis, but very few systematic reviews. This systematic review examined White and Black racial differences in the association between area-level factors and prostate cancer stage diagnosis in the United States. We systematically obtained relevant peer-reviewed articles published in English until August 30, 2022, from three databases: PubMed, Embase, and Scopus. The relevant studies included prostate cancer observational studies in adult men (18 years and older) conducted in the United States that measured one or more area-level factors at the level of a geographic unit (e.g., census tract, block group, and zip codes). We used the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to review the internal validity of the final studies. The reviewers identified 41 articles with a stage at diagnosis as an outcome, of which 11 articles (26%) statistically examined White-Black differences for the association between stage at diagnosis and an area-level factor. Most of the final 11 studies (73%) used advanced stage (regional, distant/metastatic stage) as the primary indicator variable, and two studies looked at two different outcomes (e.g., localized/early stage and tumor aggressiveness). The observed area-level factors were grouped as social (62.5%), physical/built environment (18.8%), and health service determinants (18.8%). Neighborhood socioeconomic status (SES) or deprivation composite scores (12.5%) and poverty (12.5%) were the most area-level factors reported in the studies.   There were differences in area-level factors associated with prostate cancer severity for Black and White males. Overall, the results showed that Black men were more likely to be diagnosed with advanced-stage or aggressive tumors if they resided in areas with low neighborhood SES, low environmental quality, and the highest deprived and racially segregated areas compared to Whites. The study summarized results from individual studies exploring the role of neighborhood area-level factors and prostate cancer stage racial disparities in the United States. Future studies can provide an understanding of the impact and mechanisms of the area-level social and physical environments in cancer disparities.

Citation Format: Ifeanyi B. Chukwudozie, Elle R. Martell, Ravneet Kaur, Rosie Hanneke, Vincent Freeman. Examining racial differences in area-level factors associated with prostate cancer stage at diagnosis: A systematic review [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B080.