Neighborhood deprivation and prostate cancer mortality: a multilevel analysis from Sweden.

BACKGROUND

The objective was to analyze the association between neighborhood deprivation and prostate cancer mortality, after adjusting for individual characteristics.

METHODS

This study was designed as a follow-up study of prostate cancer mortality between 1 January 1990 and 31 December 2008 in patients aged 25-74 years (a total of 73 159 patients). Multilevel logistic regression analyses were performed with individual-level characteristics at the first level and level of neighborhood deprivation at the second level.

RESULTS

The age-standardized prostate cancer mortality rate was 1.5 times higher in men living in high-deprivation neighborhoods than in those living in the most affluent neighborhoods. Mortality rates were also associated with certain individual-level characteristics, that is, age, marital status, family income, educational attainment, immigration status, urban/rural status, mobility and comorbidity. For example, there was a strong relationship between prostate cancer mortality and being unmarried, having a low income or educational attainment, and hospitalization for chronic obstructive pulmonary disease. In the full model, the risk of prostate cancer mortality was 25% higher in men living in the most deprived neighborhoods than in those living in the most affluent neighborhoods.

CONCLUSIONS

High level of neighborhood deprivation independently predicts prostate cancer mortality. This raises important clinical and public health concerns. Both individual- and neighborhood-level approaches are important in healthcare policies.