Hu Danfei, Chen Xiaodong, Li Mingyao, Xiong Huacai, Lu Xuefeng, Chen Feng
Department of Radiation Oncology, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Department of Urology, Ningbo Urology and Nephrology Hospital, Ningbo, China.
Front Public Health. 2025 Mar 12;13:1564498. doi: 10.3389/fpubh.2025.1564498. eCollection 2025.
Social determinants of health (SDoH) are increasingly recognized as key factors in addressing health inequities. This study aimed to explore the association between SDoH and risk of prostate cancer (PCa).
We analyzed data from the National Health and Nutrition Examination Survey 2003-2010. PCa diagnosis was based on self-reported questionnaires, while highly-probable PCa was assessed using prostate-specific antigen levels. Multivariate logistic regression, restricted cubic spline, and subgroup analysis were performed. Three models were employed: the crude model (unadjusted), model 1 (adjusted for age and race/ethnicity), and model 2 (further adjusted for body mass index, alcohol consumption, and smoking status).
The median age of 5,633 participants was 54 years. A negative association was found between the SDoH score and PCa prevalence (OR = 0.868, 95% CI: 0.786-0.959, = 0.006). Specifically, a family income-to-poverty ratio < 3 (OR = 0.69, 95% CI: 0.499-0.954, = 0.029) and lack of healthcare access or reliance on emergency rooms (OR = 0.429, 95% CI: 0.218-0.842, = 0.017) were independently associated with lower PCa prevalence. In model 2, no significant association was found between SDoH and highly probable PCa. A linear association between SDoH and PCa prevalence was observed. A consistently negative association was noted among participants aged ≥ 60 years, Non-Hispanic Black, Non-Hispanic White, and non-obese individuals.
The negative association between SDoH and PCa prevalence is likely attributable to inadequate screening and underreporting, rather than any protective effects. Unfavorable SDoH is not a risk factor for the onset of PCa. This study underscores the importance of addressing disparities in healthcare access and improving equity in PCa screening.
健康的社会决定因素（SDoH）日益被视为解决健康不平等问题的关键因素。本研究旨在探讨SDoH与前列腺癌（PCa）风险之间的关联。
我们分析了2003 - 2010年美国国家健康与营养检查调查的数据。PCa诊断基于自我报告问卷，而高度可能的PCa则使用前列腺特异性抗原水平进行评估。进行了多变量逻辑回归、受限立方样条分析和亚组分析。采用了三个模型：粗模型（未调整）、模型1（调整年龄和种族/族裔）和模型2（进一步调整体重指数、饮酒量和吸烟状况）。
5633名参与者的中位年龄为54岁。发现SDoH得分与PCa患病率之间存在负相关（OR = 0.868，95% CI：0.786 - 0.959，P = 0.006）。具体而言，家庭收入与贫困比率<3（OR = 0.69，95% CI：0.499 - 0.954，P = 0.029）以及缺乏医疗保健服务或依赖急诊室（OR = 0.429，95% CI：0.218 - 0.842，P = 0.017）与较低的PCa患病率独立相关。在模型2中，未发现SDoH与高度可能的PCa之间存在显著关联。观察到SDoH与PCa患病率之间存在线性关联。在年龄≥60岁的参与者、非西班牙裔黑人、非西班牙裔白人以及非肥胖个体中，一致观察到负相关。
SDoH与PCa患病率之间的负相关可能归因于筛查不足和报告不充分，而非任何保护作用。不利的SDoH不是PCa发病的风险因素。本研究强调了解决医疗保健服务差异和改善PCa筛查公平性的重要性。
