Socioeconomic status, race, and prostate cancer — the view from California

The differences in risk for and mortality from prostate cancer across racial and ethnic lines have been well documented.However, there has been continuing controversy over the degree to which socioeconomic status (SES) may be able to account for these differences.

Cheng et al. have now reported a detailed analysis of the relationship between SES and prostate cancer among African-Americans, non-Hispanic Whites, Hispanics, and Asian/Pacific Islanders by conducting a large, population-based, cross-sectional study of 98,484 incident prostate cancer cases and 8,997 prostate cancer deaths in the state of California, using data from the California Cancer Registry — one of the population-based surveillance, epidemiology, and end results (SEER) registry. Each prostate cancer case and death was assigned a multidimensional neighborhood-SES index using the 2000 US Census data. SES quintile-specific prostate cancer incidence and mortality rates and rate ratios were estimated using SEER*Stat for each race/ethnicity categorized into 10-year age groups.

The results of this study may be summarized as follows:

  • Higher SES is significantly associated with increased risk of disease.
  • Among younger men (45-64 years), African-Americans had the highest incidence rates followed by non-Hispanic whites, Hispanics, and Asian/Pacific Islanders for all SES levels.
  • Among older men (75-84 years) Hispanics, following African-Americans, displayed the second highest incidence rates of prostate cancer.
  • Higher SES is associated with lower rates of prostate cancer-specific deaths.
  • African-Americans had a twofold to fivefold increased risk of prostate cancer-specific death compared to non-Hispanic whites across all levels of SES.

The authors state that, based on these data, SES alone cannot account for the greater burden of prostate cancer among African-American men. They also point out that incidence and mortality rates for prostate cancer display different age and racial/ethnic patterns across gradients of SES.

Without wishing to “stereotype” this situation, The “New” Prostate Cancer InfoLink would note that there seems to be a certain logical pattern to these results. It has long been believed that certain cultural and genetic traits may increase the risk for prostate cancer among African Americans and Afro-Caribbeans. And many in these communities have been at the lower end of the spectrum with respect to SES, which undoubtedly affects their access to preventive, diagnostic, and medical care. Conversely, non-Hispanic whites, who tend to be “higher up” the SES spectrum, used to be more likely to get tested for prostate cancer and had the health insurance coverage allowing for good quality, early treatment when needed. Hispanics lie in between these two extremes, but older Hispanics were probably less likely to to have good quality health care insurance than may now available in this community.

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