Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, National Cancer Institute, National Institutes of Health, Bethesda, MD 20852, USA.
Cancer Causes Control. 2012 Jul;23(7):1185-91. doi: 10.1007/s10552-012-9988-8. Epub 2012 May 22.
The purpose of this study was to separately examine the impact of neighborhood socioeconomic deprivation and availability of healthcare resources on prostate cancer risk among African American and Caucasian men.
In the large, prospective NIH-AARP Diet and Health Study, we analyzed baseline (1995-1996) data from adult men, aged 50-71 years. Incident prostate cancer cases (n = 22,523; 1,089 among African Americans) were identified through December 2006. Lifestyle and health risk information was ascertained by questionnaires administered at baseline. Area-level socioeconomic indicators were ascertained by linkage to the US Census and the Area Resource File. Multilevel Cox models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).
A differential effect among African Americans and Caucasians was observed for neighborhood deprivation (p-interaction = 0.04), percent uninsured (p-interaction = 0.02), and urologist density (p-interaction = 0.01). Compared to men living in counties with the highest density of urologists, those with fewer had a substantially increased risk of developing advanced prostate cancer (HR = 2.68, 95 % CI = 1.31, 5.47) among African American.
Certain socioeconomic indicators were associated with an increased risk of prostate cancer among African American men compared to Caucasians. Minimizing differences in healthcare availability may be a potentially important pathway to minimizing disparities in prostate cancer risk.
本研究旨在分别探讨社区社会经济剥夺和医疗资源可及性对非裔美国人和白种人男性前列腺癌风险的影响。
在大型前瞻性 NIH-AARP 饮食与健康研究中，我们分析了年龄在 50-71 岁的成年男性的基线（1995-1996 年）数据。通过 2006 年 12 月的随访，确定了前列腺癌病例（n=22523；1089 例为非裔美国人）。通过基线时进行的问卷调查，确定了生活方式和健康风险信息。通过与美国人口普查和区域资源文件的链接，确定了区域社会经济指标。使用多水平 Cox 模型估计风险比（HR）和 95%置信区间（CI）。
观察到社区贫困（p 交互作用=0.04）、未参保比例（p 交互作用=0.02）和泌尿科医生密度（p 交互作用=0.01）对非裔美国人和白种人之间的差异有影响。与居住在泌尿科医生密度最高的县的男性相比，居住在泌尿科医生密度较低的县的男性发生晚期前列腺癌的风险显著增加（HR=2.68，95%CI=1.31，5.47）。
与白种人相比，某些社会经济指标与非裔美国男性前列腺癌风险增加相关。减少医疗资源可及性的差异可能是减少前列腺癌风险差异的一个潜在重要途径。
