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01-03-2020 | Prostate Cancer | Original Paper

Patient- and area-level predictors of prostate cancer among South Carolina veterans: a spatial analysis

Authors: Peter Georgantopoulos, Jan M. Eberth, Bo Cai, Christopher Emrich, Gowtham Rao, Charles L. Bennett, Kathlyn S. Haddock, James R. Hébert

Published in: Cancer Causes & Control | Issue 3/2020

Abstract

Background

Racial and socio-economic status (SES) disparities exist in prostate cancer (PrCA) incidence and mortality. Less is known regarding how geographical factors, including neighborhood social vulnerability and distance traveled to receive care, affect PrCA risk. The purpose of this research was to use the Veterans Administration Medical System, which provides a unique means for studying PrCA epidemiology among diverse individuals with ostensibly equal access to healthcare, to determine whether area-level characteristics influence PrCA incidence while accounting for individual-level risk factors.

Methods

From the US Veteran’s Health Administration (VHA) electronic medical records (EMR) database from January 1999 to December 2015, we identified 3,736 PrCA patients and 104,017 cancer-free controls from South Carolina (SC). The VHA EMRs were linked to the US census which provided area-level factors. US census data were used to construct the Social Vulnerability Index which is a continuous composite measure of area-level vulnerability and was divided into tertiles for modeling purposes. Data were analyzed using a Bayesian multivariate conditional autoregressive model (CAR) which accounted for individual-level factors, area-level factors, spatial random effects, and autocorrelation, which were used to identify areas of higher- or lower-than-expected PrCA incidence after controlling for risk factors.

Results

As expected, after accounting for age (sixfold and 13-fold increases in men 40–50 years and > 50 years, respectively), race was an important risk factor, with threefold higher odds among Blacks in the fully adjusted model [OR_adj 2.98 (2.77, 3.20)]. After accounting for all other factors, residing in a ZIP code tabulated areas (ZCTA) with the greatest level social vulnerability versus the lowest, least vulnerable ZCTA’s, increased PrCA risk by 39% [OR_adj 1.39 (1.11, 1.75)].

Conclusions

While accounting for known risk factors for PrCA, including age, race, and marital status, we found geographic areas in SC characterized by higher than average social vulnerability with higher rates of incident PrCA among veterans. Outreach for screening, education, and care coordination may be needed for veterans in these areas.

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Title: Patient- and area-level predictors of prostate cancer among South Carolina veterans: a spatial analysis
Authors: Peter Georgantopoulos
Jan M. Eberth
Bo Cai
Christopher Emrich
Gowtham Rao
Charles L. Bennett
Kathlyn S. Haddock
James R. Hébert
Publication date: 01-03-2020
Publisher: Springer International Publishing
Keywords: Prostate Cancer
Prostate Cancer
Published in: Cancer Causes & Control / Issue 3/2020
Print ISSN: 0957-5243
Electronic ISSN: 1573-7225
DOI: https://doi.org/10.1007/s10552-019-01263-2

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Abstract

Background

Methods

Results

Conclusions

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