Geographic risk for advanced and metastatic prostate cancer

New research data on the epidemiology of advanced prostate cancer here in the US has confirmed something that has long been understood (albeit not previously as well documented).

In their new paper in Clinical Medicine Insights: Oncology, Jayasekera et al. have now shown that — at least for older, Medicare-eligible men:

… low intensity of annual prostate-specific antigen (PSA) testing and other preventive health behavior, high comorbidity, African American race, and lower county socioeconomic and health services supply characteristics were statistically significantly associated with a higher likelihood of distant prostate cancer diagnosis. The fully adjusted predicted proportions of advanced prostate cancer diagnosis across 158 counties ranged from 3% to 15% …. County-level socioeconomic and health services supply characteristics, individual-level preventive health behavior, demographic and clinical characteristics are determinants of advanced stage prostate cancer diagnosis among older Medicare beneficiaries; other health care-related factors such as family history, lifestyle choices, and health-seeking behavior should also be considered as explanatory factors.

It has long been understood that this was almost certainly the case.

When people have less access to high-quality health services, there is an almost inevitable increase in risk for and progression of a whole spectrum of serious and chronic disorders. And most high-quality and speciality-based medical services in America are clustered around major urban centers and their suburbs, with rural America being much more dependent on primary care providers who may be dealing with populations spread across very large areas of land.

Given these circumstances, it is almost inevitable that rural populations here in the US — regardless of race and other factors — are going to be at higher risk of delayed diagnosis of disorders like prostate cancer that have no clear, early symptoms (especially if the availability of necessary transportation to actually visit a doctor for regular check-ups is also limited for older men).

This paper is also discussed in some detail in commentary on the Renal & Urology News web site.

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