# Individual income and race-associated differences in prostate cancer mortality in a statewide registry

## TL;DR

This study found that racial disparities in prostate cancer mortality disappear when individual wealth and social factors are considered.

## Contribution

The study introduces individual home prices as a novel metric to assess socioeconomic status in cancer outcomes.

## Key findings

- Black men had higher prostate cancer mortality risk when only age and diagnosis year were considered.
- Incorporating social determinants and home prices eliminated racial disparities in mortality.
- Other-cause mortality rates were similar between Black and White men after adjusting for social factors.

## Abstract

Prior studies evaluating racial disparities in cancer outcomes used regional measures of deprivation when accounting for socioeconomic status, which lack granularity. We evaluated differences in prostate cancer mortality between Black and White men using individual home prices in addition to regional metrics to understand the impact of individual wealth on prostate cancer outcomes.

Individuals diagnosed with prostate cancer between January 2004 and December 2016 in the Ohio Cancer Incidence Surveillance System were included. Individual home addresses were linked to the Area Deprivation Indices and home prices using data from an online real estate marketplace. Using inverse probability weighting to balance patient characteristics, we assessed differences in prostate cancer–specific mortality or other-cause mortality between Black and White men after accounting for clinical characteristics and social determinants of health (insurance, area deprivation, and home price).

We identified 70 660 (85%) White and 12 192 (15%) Black men with prostate cancer. Black race was associated with a higher risk of prostate cancer–specific mortality in models that adjusted for age and year at diagnosis (subdistribution hazard ratio = 1.45, 95% CI = 1.45 to 1.57) and with the addition of cancer variables (subdistribution hazard ratio = 1.16, 95% CI = 1.06 to 1.26). In models that incorporate social determinants of health, however, rates of prostate cancer–specific mortality and other-cause mortality were not statistically significantly higher for Black men (subdistribution hazard ratios = 1.10, 95% CI = 0.98 to 1.24, and 1.02, 95% CI = 0.95 to 1.09), respectively.

After accounting for clinical characteristics and social determinants of health at the individual level, Black men were not at increased risk of prostate cancer mortality relative to White men.