Relationship between marital status and prostate cancer stage of diagnosis in Florida

Background: The detrimental effect of unmarried marital status on stage and survival has been confirmed in several cancers. The objective of this study was to determine if an association exists between marital status and prostate cancer (PC) stage of diagnosis after adjusting for age, race/ethnicity, education level, smoking and insurance status, SES and urban/rural residence. Methods: The Florida Cancer Data System was used to obtain data (n=97,682) from men diagnosed with PC between 2001 and 2009 of which 78% were married. US Census data was used to construct area-based socioeconomic measures of education and SES. Most men had localized PC (89%) at diagnosis compared to those with an advanced (regional/distant) stage (11%). Univariate and multivariate logistic regression models were fitted to stage of PC presentation (advanced vs. localized) with marital status as the main predictor but further adjusted for sociodemographic factors. Analyses were also stratified by race/ethnicity. Results: Unmarried men were more likely to present with advanced disease than married men (OR [1.35];95%CI:1.29–1.41). After adjusting for sociodemographic factors, this association remained ([1.24];1.19–1.30). In the stratified analysis, unmarried Black men ([1.5];1.34–1.7) followed by Hispanics ([1.38];1.2–1.6) and Whites ([1.17];1.10–1.24) were the most likely to present with late stage PC. Conclusions: Unmarried men were significantly more likely to present with advanced disease. Marriage is one of the most important types of social support. Further research is warranted into the effects of social support in PC screening and treatment.