Journal article
Patient- and area-level predictors of prostate cancer among South Carolina veterans: a spatial analysis
Cancer causes & control, v 31(3), pp 209-220
01 Mar 2020
PMID: 31975155
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Racial and socio-economic status (SES) disparities exist in prostate cancer (PrCA) incidence and mortality. Less is known regarding how geographical factors, including neighborhood social vulnerability and distance traveled to receive care, affect PrCA risk. The purpose of this research was to use the Veterans Administration Medical System, which provides a unique means for studying PrCA epidemiology among diverse individuals with ostensibly equal access to healthcare, to determine whether area-level characteristics influence PrCA incidence while accounting for individual-level risk factors.
From the US Veteran's Health Administration (VHA) electronic medical records (EMR) database from January 1999 to December 2015, we identified 3,736 PrCA patients and 104,017 cancer-free controls from South Carolina (SC). The VHA EMRs were linked to the US census which provided area-level factors. US census data were used to construct the Social Vulnerability Index which is a continuous composite measure of area-level vulnerability and was divided into tertiles for modeling purposes. Data were analyzed using a Bayesian multivariate conditional autoregressive model (CAR) which accounted for individual-level factors, area-level factors, spatial random effects, and autocorrelation, which were used to identify areas of higher- or lower-than-expected PrCA incidence after controlling for risk factors.
As expected, after accounting for age (sixfold and 13-fold increases in men 40-50 years and > 50 years, respectively), race was an important risk factor, with threefold higher odds among Blacks in the fully adjusted model [OR
2.98 (2.77, 3.20)]. After accounting for all other factors, residing in a ZIP code tabulated areas (ZCTA) with the greatest level social vulnerability versus the lowest, least vulnerable ZCTA's, increased PrCA risk by 39% [OR
1.39 (1.11, 1.75)].
While accounting for known risk factors for PrCA, including age, race, and marital status, we found geographic areas in SC characterized by higher than average social vulnerability with higher rates of incident PrCA among veterans. Outreach for screening, education, and care coordination may be needed for veterans in these areas.
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Details
- Title
- Patient- and area-level predictors of prostate cancer among South Carolina veterans: a spatial analysis
- Creators
- Peter Georgantopoulos - University of South CarolinaJan M Eberth - University of South CarolinaBo Cai - University of South CarolinaChristopher Emrich - University of Central FloridaGowtham Rao - University of South CarolinaCharles L Bennett - University of South CarolinaKathlyn S Haddock - Columbia VA Health Care SystemJames R Hébert - University of South Carolina
- Publication Details
- Cancer causes & control, v 31(3), pp 209-220
- Publisher
- Springer Nature
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Health Management and Policy
- Web of Science ID
- WOS:000514796100001
- Scopus ID
- 2-s2.0-85078331504
- Other Identifier
- 991021855277704721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Oncology
- Public, Environmental & Occupational Health