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- Title
Neighborhood Deprivation, Race and Ethnicity, and Prostate Cancer Outcomes Across California Health Care Systems.
- Authors
Wadhwa, Ananta; Roscoe, Charlotte; Duran, Elizabeth A.; Kwan, Lorna; Haroldsen, Candace L.; Shelton, Jeremy B.; Cullen, Jennifer; Knudsen, Beatrice S.; Rettig, Mathew B.; Pyarajan, Saiju; Nickols, Nicholas G.; Maxwell, Kara N.; Yamoah, Kosj; Rose, Brent S.; Rebbeck, Timothy R.; Iyer, Hari S.; Garraway, Isla P.
- Abstract
This cohort study compares all-cause mortality by neighborhood deprivation and race and ethnicity among individuals with prostate cancer receiving care in the US Department of Veterans Affairs (VA) health care system vs those receiving care outside the VA. Key Points: Question: Does the magnitude of racial and ethnic and neighborhood socioeconomic disparities vary among individuals with prostate cancer residing in the same neighborhoods but seeking care in different health care systems? Findings: In this cohort study of 49 461 patients with prostate cancer, higher neighborhood deprivation was associated with worse survival in patients who received care in the community health care system compared with the relatively equal-access US Department of Veterans Affairs (VA) system. The racial disparities in all-cause mortality were significantly wider in the community health care population compared with the VA population. Meaning: Findings of this study suggest that interventions targeting access barriers experienced by patients with prostate cancer with lower socioeconomic status may mitigate neighborhood socioeconomic and racial disparities. Importance: Non-Hispanic Black (hereafter, Black) individuals experience worse prostate cancer outcomes due to socioeconomic and racial inequities of access to care. Few studies have empirically evaluated these disparities across different health care systems. Objective: To describe the racial and ethnic and neighborhood socioeconomic status (nSES) disparities among residents of the same communities who receive prostate cancer care in the US Department of Veterans Affairs (VA) health care system vs other settings. Design, Setting, and Participants: This cohort study obtained data from the VA Central Cancer Registry for veterans with prostate cancer who received care within the VA Greater Los Angeles Healthcare System (VA cohort) and from the California Cancer Registry (CCR) for nonveterans who received care outside the VA setting (CCR cohort). The cohorts consisted of all males with incident prostate cancer who were living within the same US Census tracts. These individuals received care between 2000 and 2018 and were followed up until death from any cause or censoring on December 31, 2018. Data analyses were conducted between September 2022 and December 2023. Exposures: Health care setting, self-identified race and ethnicity (SIRE), and nSES. Main Outcomes and Measures: The primary outcome was all-cause mortality (ACM). Cox proportional hazards regression models were used to estimate hazard ratios for associations of SIRE and nSES with prostate cancer outcomes in the VA and CCR cohorts. Results: Included in the analysis were 49 461 males with prostate cancer. Of these, 1881 males were in the VA cohort (mean [SD] age, 65.3 [7.7] years; 833 Black individuals [44.3%], 694 non-Hispanic White [hereafter, White] individuals [36.9%], and 354 individuals [18.8%] of other or unknown race). A total of 47 580 individuals were in the CCR cohort (mean [SD] age, 67.0 [9.6] years; 8183 Black individuals [17.2%], 26 206 White individuals [55.1%], and 13 191 individuals [27.8%] of other or unknown race). In the VA cohort, there were no racial disparities observed for metastasis, ACM, or prostate cancer–specific mortality (PCSM). However, in the CCR cohort, the racial disparities were observed for metastasis (adjusted odds ratio [AOR], 1.36; 95% CI, 1.22-1.52), ACM (adjusted hazard ratio [AHR], 1.13; 95% CI, 1.04-1.24), and PCSM (AHR, 1.15; 95% CI, 1.05-1.25). Heterogeneity was observed for the racial disparity in ACM in the VA vs CCR cohorts (AHR, 0.90 [95% CI, 0.76-1.06] vs 1.13 [95% CI, 1.04-1.24]; P =.01). No evidence of nSES disparities was observed for any prostate cancer outcomes in the VA cohort. However, in the CCR cohort, heterogeneity was observed for nSES disparities with ACM (AHR, 0.82; 95% CI, 0.80-0.84; P =.002) and PCSM (AHR, 0.86; 95% CI, 0.82-0.89; P =.007). Conclusions and Relevance: Results of this study suggest that racial and nSES disparities were wider among patients seeking care outside of the VA health care system. Health systems–related interventions that address access barriers may mitigate racial and socioeconomic disparities in prostate cancer.
- Subjects
UNITED States; MEDICAL care of veterans; RESEARCH funding; RESIDENTIAL patterns; MULTIPLE regression analysis; PROSTATE tumors; DESCRIPTIVE statistics; REPORTING of diseases; CANCER patients; RACE; MULTIHOSPITAL systems; LONGITUDINAL method; METASTASIS; KAPLAN-Meier estimator; LOG-rank test; ODDS ratio; HEALTH equity; CONFIDENCE intervals; NEIGHBORHOOD characteristics; SOCIAL classes; PROPORTIONAL hazards models
- Publication
JAMA Network Open, 2024, Vol 7, Issue 3, pe242852
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.2852