Kathryn Barry

Ph.D., M.P.H.

University of Maryland, Baltimore

Assistant Professor

PLCO (Learn more about this study)

PLCO-1428

Dec 26, 2023

Neighborhood disadvantage and aggressive prostate cancer among African American and European American men

Compared to European American (EA) men, African American (AA) men are more than 1.5 times as likely to develop prostate cancer and more than 2 times as likely to die from prostate cancer (Siegel et al, 2023). In addition to other contributing factors, such as access to care (Powell, 2007; Pietro et al, 2016), there is evidence that AA men are more likely to develop aggressive disease, which is more likely to be fatal (Powell, 2007); however, the reasons are not fully understood.

Growing data suggest that neighborhood disadvantage (e.g., neighborhood socioeconomic deprivation), which disproportionately affects AA individuals (Onukwugha et al, 2014; Jayasekera et al, 2019), is associated with a higher likelihood of advanced or aggressive prostate cancer (Jayasekera et al, 2019; Coughlin, 2020; Zeigler-Johnson et al, 2011; Lynch et al, 2017) and therefore may contribute significantly to disparities. Among other mechanisms, neighborhood disadvantage may increase cancer risk and aggressiveness in part via an increased allostatic load due to chronic stress (Gehlert et al, 2008; Taylor et al, 1997; Lord et al, 2023). However, there has been little previous study of whether race and neighborhood disadvantage interact to further increase the risk of aggressive prostate cancer. Additionally, there has been little study of racial segregation or historical redlining and their interplay with race, although these are important neighborhood level factors conferring disadvantage (Williams and Collins, 2001; Ashing et al, 2021). Our central hypothesis, which is supported by our preliminary data, is that neighborhood disadvantage will increase the likelihood of developing aggressive prostate cancer and that associations will be stronger among AA than EA men. Using data for men treated for prostate cancer at the University of Maryland, we found that neighborhood socioeconomic deprivation – based on the publicly-available Area Deprivation Index and a Bayesian-based Neighborhood Deprivation Index that was developed and validated by our group (Wheeler et al, 2017; Wheeler et al, 2021), racial segregation (based on the Racial Isolation Index; Anthopolos et al, 2011), and historical redlining were associated with an increased likelihood of aggressive disease. Associations tended to be stronger among AA men, particularly for neighborhood deprivation.

The objective of the current proposed study is to comprehensively evaluate neighborhood disadvantage based on neighborhood socioeconomic deprivation, racial segregation, and historical redlining over the life-course in relation to the risk of developing aggressive prostate cancer, as well as the likelihood of developing aggressive vs. non-aggressive prostate cancer, both overall and separately by race. We will leverage participant residential histories in PLCO, which are available for a large proportion of the cohort. Additionally, we will make use of the rich individual-level data in PLCO (e.g., individual income or education) as covariates for adjustment or consideration as potential effect modifiers in multi-level models (i.e., whether individual-level factors may interact with neighborhood factors to further increase risk). Findings will advance understanding regarding the interplay of race and neighborhood factors in aggressive prostate cancer and will have important applications in developing interventions to reduce aggressive disease and prostate cancer disparities.

Aim 1: Evaluate neighborhood disadvantage in relation to the risk of aggressive prostate cancer (compared to men who did not develop prostate cancer) using large established prospective cohorts, including PLCO – overall and separately by race (AA vs. EA). First, we will evaluate the neighborhood factors based on a single address (for example, address at or around the time of study baseline). Then we will assess a dose-response relationship between duration of residence in disadvantaged areas and aggressive prostate cancer using residential histories. Hypothesis: Neighborhood disadvantage (including neighborhood socioeconomic deprivation, racial segregation, and historical redlining) over the life-course will be associated with an increased risk of aggressive prostate cancer and associations will be stronger among AA than EA men.

Aim 2: Evaluate neighborhood disadvantage (same factors as Aim 1) in relation to the likelihood of aggressive vs. non-aggressive prostate cancer using data from PLCO and other studies/institutions – overall and separately by race (AA vs. EA). First, we will evaluate the neighborhood factors based on a single address (for example, address at or around the time of diagnosis). Then we will assess a dose-response relationship between duration of residence in disadvantaged areas and aggressive prostate cancer using residential histories. Hypothesis: Neighborhood disadvantage over the life-course will be associated with an increased likelihood of aggressive vs. non-aggressive prostate cancer and associations will be stronger among AA than EA men.