Racial/ethnic disparities in the cause of death among patients with prostate cancer in the United States from 1995 to 2019: a population-based retrospective cohort study

Hongmei Zeng; Mengyuan Xu; Yingwei Xie; Sergiusz Nawrocki; Jakub Morze; Xianhui Ran; Tianhao Shan; Changfa Xia; Yixin Wang; Lingeng Lu; Xue Qin Yu; Catarina Machado Azeredo; John S Ji; Xiaomei Yuan; Katherine Curi-Quinto; Yuexin Liu; Bingsheng Liu; Tao Wang; Hao Ping; Edward L Giovannucci

doi:10.1016/j.eclinm.2023.102138

Racial/ethnic disparities in the cause of death among patients with prostate cancer in the United States from 1995 to 2019: a population-based retrospective cohort study

EClinicalMedicine. 2023 Aug 3:62:102138. doi: 10.1016/j.eclinm.2023.102138. eCollection 2023 Aug.

Authors

Hongmei Zeng^{1

2}, Mengyuan Xu¹, Yingwei Xie³, Sergiusz Nawrocki^{4

5}, Jakub Morze^{6

2}, Xianhui Ran¹, Tianhao Shan¹, Changfa Xia¹, Yixin Wang², Lingeng Lu⁷, Xue Qin Yu⁸, Catarina Machado Azeredo⁹, John S Ji¹⁰, Xiaomei Yuan¹¹, Katherine Curi-Quinto^{12

13}, Yuexin Liu³, Bingsheng Liu¹⁴, Tao Wang¹⁴, Hao Ping^{3

15}, Edward L Giovannucci^{2

16}

Affiliations

¹ National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
³ Department of Urology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
⁴ Department of Oncology, Collegium Medicum University of Warmia and Mazury in Olsztyn, Wojska Polskiego 37, 10-228 Olsztyn, Poland.
⁵ Department of Radiotherapy, Hospital of the Ministry of Internal Affairs with Warmia and Mazury Oncology Center in Olsztyn, Wojska Polskiego 37, 10-228 Olsztyn, Poland.
⁶ College of Medical Sciences, SGMK University, Olsztyn, Poland.
⁷ Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale Cancer Center, Yale University, New Haven, CT 06510, USA.
⁸ The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council New South Wales, Sydney, NSW, Australia.
⁹ School of Medicine, Federal University of Uberlandia, Uberlandia, Brazil.
¹⁰ Vanke School of Public Health, Tsinghua University, Beijing, China.
¹¹ Department of Outpatient, NO.20 Retired Cadre Sanatorium, Haidian District, Beijing.
¹² Universidad San Ignacio de Loyola, Facultad de Ciencias de la Salud, Lima 15024, Peru.
¹³ Instituto de Investigación Nutricional (IIN), Lima 15024, Peru.
¹⁴ School of Public Policy and Administration, Chongqing University, No.174 Shazhengjie, Shapingba District, Chongqing, China.
¹⁵ Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University and Capital Medical University, Beijing Tongren Hospital, Beijing, China.
¹⁶ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.

Abstract

Background: Racial/ethnic disparities in prostate cancer are reported in the United States (US). However, long-term trends and contributors of racial/ethnic disparities in all-cause and cause-specific death among patients with prostate cancer remain unclear. We analysed the trends and contributors of racial/ethnic disparities in prostate cancer survivors according to the cause of death in the US over 25 years.

Methods: In this retrospective, population-based longitudinal cohort study, we identified patients diagnosed with first primary prostate cancer between 1995 and 2019, with follow-up until Dec 31, 2019, using population-based cancer registries' data from the Surveillance, Epidemiology, and End Results (SEER) Program. We calculated the cumulative incidence of death for each racial/ethnic group (Black, white, Hispanic, Asian or Pacific Islander [API], and American Indian or Alaska Native [AI/AN] people), by diagnostic period and cause of death. We quantified absolute disparities using rate changes for the 5-year cumulative incidence of death between racial/ethnic groups and diagnostic periods. We estimated relative (Hazard ratios [HR]) racial/ethnic disparities and the percentage of potential factors contributed to racial/ethnic disparities using Cox regression models.

Findings: Despite a decreasing trend in the cumulative risk of death across five racial/ethnic groups, AI/AN and Black patients consistently had the highest rate of death between 1995 and 2019 with an adjusted HR of 1.48 (1.40-1.58) and 1.40 (1.38-1.42) respectively. The disparities in all-cause mortality between AI/AN and white patients increased over time, with adjusted HR 1.32 (1.17-1.49) in 1995-1999 and 1.95 (1.53-2.49) in 2015-2019. Adjustment of stage at diagnosis, initial treatment, tumor grade, and household income explained 33% and 24% of the AI/AN-white and Black-white disparities in all-cause death among patients with prostate cancer.

Interpretation: The enduring racial/ethnic disparities in patients with prostate cancer, call for new interventions to eliminate health disparities. Our study provides important evidence and ways to address racial/ethnic inequality.

Funding: National Key R&D Program of China, National Natural Science Foundation of China, Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support, the Open Research Fund from Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Key Projects of Philosophy and Social Sciences Research, Ministry of Education of China.

Keywords: Cause-specific death; Prostate cancer; Racial/ethnic disparities; The United States.