Abstract 4858: Examining state- and race-specific five-year prostate cancer mortality rates (2016-2020) and their association with prostate-specific antigen screening
Authors: Guard Hannah E. , Vaselkiv Jane B. , Ecsedy Ethan , Kuechen Florian , Minassian Nareg , Rappaport James Dun , Qian Zhiyu , Sodipo Michelle O. , Penney Kathryn L. , Stopsack Konrad H. , Mucci Lorelei A. 
Published: March 2024

Abstract
Background: In 2023, 34,000 US men will die from prostate cancer. The impact of prostate cancer mortality varies greatly across states. Racial differences in state populations may explain some but not all of this variability. This study examined prostate cancer mortality rates by state and race and their associations with state-level prostate-specific antigen (PSA) screening prevalence.
Methods: We obtained race-specific, state level five-year average age-standardized prostate cancer mortality rates from 2016-2020 from the NCI State Cancer Profiles. Data on race-specific, state level PSA screening prevalence in 2010 were obtained from the Behavioral Risk Factor Surveillance System. We compared mortality rate ratios (RR, 95% confidence intervals [CI]) of state level prostate cancer mortality rates of Black, Hispanic, Asian/Pacific Islander, and American Indian/Alaskan Native men to White men. We generated descriptive statistics (median and range) on state level mortality rates to quantify the variability within racial/ethnic groups. We fit univariable Poisson regression models to explore associations between prostate cancer mortality rates and PSA screening prevalence, for White, Black, and Hispanic men, but omitted Asian and American Indian men due to sparse data.
Results: Mortality data were available for 50 states and the District of Columbia (D.C.) for White, 40 states and D.C. for Black, 36 states for Hispanic, 24 states for Asian, and 11 states for American Indian men. The US average prostate cancer mortality rate was 18.8 deaths per 100,000 per year. As expected, rates were higher among Black than White men (RR 2.07; 1.90, 2.24), while rates among Hispanic (RR 0.75; 0.68, 0.84) and Asian (RR 0.48; 0.41, 0.56) men were lower. Rates among American Indian men were slightly higher than White men (RR 1.12; 0.96, 1.29). Variability of state-level mortality rates within each race was quite high, with largest ranges for Black and American Indian men. Black men had a median (range) state-level prostate cancer mortality rate of 37.9 (23.9 to 49.2), and American Indian men had a median rate of 20.4 (7.7 to 28.9). Median (range) rates were 17.7 (11.3 to 22.3) for White, 8.3 (4.3 to 17.4) for Asian, and 13.5 (8.9 to 22.5) for Hispanic men. Associations between a 5-percentage point increase in PSA screening prevalence and prostate cancer mortality rates were RR 0.92 (95% CI: 0.84, 0.99) in White, RR 0.96 (0.88, 1.05) in Black, and 0.98 (0.90, 1.07) in Hispanic men.
Conclusion: There is considerable variability in prostate cancer mortality rates across states, both between and within racial/ethnic groups, highlighting complexity of racial disparities. PSA screening may weakly contribute to this variability, but other factors such as health care access, social determinants, and lifestyle factors that vary between states should be considered in future studies.
Citation Format: Hannah E. Guard, Jane B. Vaselkiv, Ethan Ecsedy, Florian Kuechen, Nareg Minassian, James Dun Rappaport, Zhiyu Qian, Michelle O. Sodipo, Kathryn L. Penney, Konrad H. Stopsack, Lorelei A. Mucci. Examining state- and race-specific five-year prostate cancer mortality rates (2016-2020) and their association with prostate-specific antigen screening [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4858.