The 131st Annual Meeting (November 15-19, 2003) of APHA

The 131st Annual Meeting (November 15-19, 2003) of APHA

4198.0: Tuesday, November 18, 2003 - 2:35 PM

Abstract #73737

Role of Area Level Influences on Prostate Cancer Grade and Stage at Diagnosis

Ann C Klassen, PhD1, Frank C. Curriero, PhD2, JeanHee Hong, MPH1, Chyvette T Williams, MPH3, Martin Kulldorff, PhD4, Helen Meissner, PhD5, Anthony Alberg, PhD, MPH6, and Margaret E. Ensminger, PhD7. (1) Faculty of Social and Behavioral Sciences, Department of Health Policy and Management, Johns Hopkins School of Public Health, 624 N Broadway, Baltimore, MD 21205, 410 955 2218,, (2) School of Hygiene and Public Health, Department of Biostatistics, Johns Hopkins University, 615 N. Wolfe St, Baltimore, MD 21205-2179, (3) Johns Hopkins Bloomberg School of Public Health, 1629 E Baltimore St, Baltimore, MD 21231, (4) Division of Epidemiology & Biostatistics, Department of Community Medicine, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-6325, (5) Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, Rockville, MD 20852, (6) Department of Epidemiology, Johns Hopkins Sch of Public Health, 615 N Wolfe St, Baltimore, MD 21205, (7) Dept. of Health Policy & Management, Johns Hopkins School of Hygiene, 624 N. Broadway, 7th floor, Baltimore, MD 21205

To better understand the effect of social factors on prostate cancer burden, we explored the role of area-level social characteristics on prostate cancer grade and stage. We geocoded 23,993 Maryland prostate cancer cases, and linked each case to 1990 Census data. We examined the effect of 17 area-level social variables, testing each variable at the blockgroup, tract, and county level, and modeled individual and multi-level predictors of later stage and more aggressive tumor grade. Younger age, black race, aggressive tumor grade, ungraded tumor, and earlier year of diagnosis were associated with later stage. In addition, blockgroup level percentage of white collar workers (0.93, 95% Confidence Interval (C.I.)=0.89,0.98), and county level socioeconomic resources (0.94, 95% C.I.=0.89,0.98), were protective of later stage. Older age, black race, later or missing stage and earlier year of diagnosis were associated with more aggressive tumor grade. In addition, blockgroup median household income was protective for white men (0.94, 95% C.I.=0.89, 0.99), but, for all men, county socioeconomic resources were associated with increased risk of aggressive tumor (1.26, 95% C.I.=1.18, 1.35). Area-level social resources did not significantly reduce racial differences. Area-level social characteristics are associated with prostate cancer burden; however, tumor biology appears to be associated with relative resources, with the best outcomes associated with greater small area wealth in counties of lower overall resources. Stage appears to be associated with absolute resources, with the best outcomes associated with greater small area social class in counties with greater overall resources.

Learning Objectives:

Keywords: Cancer, Social Class Measurement

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Epidemiologic Research on Social Determinants of Prostate Cancer: The Role of GIS Methods and Spatial Statistics

The 131st Annual Meeting (November 15-19, 2003) of APHA