Multi-level factors associated with overall mortality among prostate cancer men in Florida

Background: Screening and treatment of prostate cancer remain controversial while tens of thousands of men die each year from the disease.

Purpose: To identify individual and contextual factors contributing to overall prostate cancer mortality in Florida.

Methods: Using cases diagnosed with prostate cancer between 10/1/2001 and 12/31/2007 in the Florida Cancer Data System. Patient's demographics, type of health insurance at diagnosis, tumor stage, treatment and all-cause death were extracted. Socioeconomic status & farm house presence were extracted from Census 2000 and linked to patient data. Comorbidity was computed following Elixhauser Index. Multi-level logistic regression was conducted to identify significant individual and contextual factors to overall mortality among the prostate cancer patients.

Results: 60,497 patients were identified, among whom 8,125 died. Being older at diagnosis, unmarried, current smoker, uninsured, diagnosed at late stage, with undifferentiated or unknown tumor grade and poorly differentiated tumor grade were significantly associated with overall mortality. Interaction between stage and grade showed more detrimental late-stage effect as grade worsened and increasingly disadvantageous grade effect at later stage of diagnosis. Low educational attainment within census tract was significantly related to mortality. After adjusting for age, stage and tumor grade, patients who received other treatments, except for those who underwent combined surgery and radiation therapy, were more likely to die compared to those having surgery only. Several major comorbidities: congestive heart failure, paralysis, diabetes, etc. were associated with increased risk of mortality.

Conclusions: Demographics, stage, comorbidity and treatment are associated with overall mortality among prostate cancer patients.