Is There an Association Between Black Race and Mortality From Prostate Cancer?
Posted: Tuesday, June 18, 2019
When investigators adjusted for nonbiologic differences such as access to care and standardized treatment, black race was not found to be associated with an inferior stage-for-stage prostate cancer–specific mortality. However, black men did have higher rates of other-cause mortality. Robert T. Dess, MD, of the University of Michigan, and colleagues published the results of a multiple-cohort study in JAMA Oncology.
“These results suggest that efforts are needed to address the modifiable social factors contributing to racial disparity in prostate cancer,” concluded the authors.
The study included 306,100 patients from three different cohorts: Surveillance, Epidemiology, and End Results (SERR), five equal-access medical centers in the Veterans Affairs (VA) health system, and four pooled National Cancer Institute–sponsored Radiation Therapy Oncology Group phase III randomized clinical trials (RCTs). Black men comprised 17.8% of the SEER cohort, 38.1% of the VA cohort, and 19.3% of the RCT cohort. Black men in the SEER cohort had a lower socioeconomic status and lower rates of non-Medicaid insurance as well as a higher percentage of high-risk disease.
Black race was associated with an increased age-adjusted prostate cancer–specific mortality hazard (subdistribution hazard ratio = 1.30) within the SEER cohort. After inverse probability weighting adjustment was applied (taking into account demographic, cancer, and treatment-related baseline differences), black race was seen to have a 0.5% increase in prostate cancer–specific mortality at 10 years postdiagnosis. There were no significant differences found in disease specific mortality in the VA cohort (where there is equal access to care) after inverse probability weighting adjustment, whereas black men actually had a lower hazard in the RCT cohort after adjustment. Black men did have an increased hazard of other-cause mortality in both the SEER and RCT cohorts (subdistribution hazard ratios = 1.30 and 1.17, respectively).
Disclosure: The study authors’ disclosure information may be found at jamanetwork.com.