Examining Potential Mediators of the Association of Neighborhood SES with Prostate Cancer Survival

Prostate cancer is the most common non-melanoma cancer among men and the second leading cause of cancer death among men in the United States. Despite survival rates greater than 98% for local stage disease, non-Hispanic Black / non-Hispanic White differences in prostate cancer survival remain. Non-Hispanic Black men, who are more likely to reside in socioeconomically disadvantaged areas, have the highest death rate for prostate cancer of any racial or ethnic group in the US. Low SES census tract or block group is associated with lower prostate cancer-specific survival. Racial/ethnic prostate cancer death-related disparities tend to be attenuated in analyses that also account for area-level SES. This study investigated the potential mediators of the relationship between area-level socioeconomic status, as measured by a composite variable called concentrated disadvantage, and prostate cancer survival to shed light on non-Hispanic Black non-Hispanic White prostate-specific survival differences. Findings include that equalizing by hospital medical affiliation, hospital safety net designation, hospital prostate cancer treatment volume or surgery with curative intent reduces the association between census-tract concentrated disadvantage and prostate cancer survival. Differences were found between which mediators were most effective for non-Hispanic Black men compared to non-Hispanic White men such that surgery and safety net status were the mediators of greatest influence among non-Hispanic Black men and medical school affiliation and hospital prostate cancer treatment volume were the mediators or greatest influence among non-Hispanic White men.