Characteristics of Philadelphia Census Tracts with High Prostate Cancer Risk Charnita Zeigler-Johnson, PhD, MPH Thomas Jefferson University Philadelphia, PA
Using Cancer Registry Data in Disparities Research Relatively complete sample of cancer patients Assess cancer incidence, mortality, and tumor characteristics Identify high risk populations Geocoded addresses linked to other databases Examine proximity to and density of health care resources Examine social determinants associated with cancer Build multi-level models
Research Framework: Multilevel Model for Health Disparities Upstream Upstream Factors Factors Factors Social Conditions and Policies Institutions Social/Physical Context Social Relationships Fundamental Causes Social and Physical Context Disparate Health Outcomes Downstream Downstream Factors Factors Individual Risk Factors Individual Demographic and Risk Factors Biologic/Genetic Pathways (Warnecke et al., AJPH 2008) Biologic Responses and Pathways
) US Incidence and Mortality of Prostate Cancer Cases by Race (per 100,000) SEER data 2017
Prostate Cancer Incidence and Survival Lifetime Probability of Prostate Cancer Diagnosis 1 in 7 men 5-year Survival % New Cases 5-yr. Survival Local stage 81% 100% Regional stage 12% 100% Distant stage 4% 28% Unknown stage 3% 73% SEER; American Cancer Society, Inc., 2014 Zeigler-Johnson
A Neighborhood-Based Intervention to Reduce Prostate Cancer Disparities (DOD W81XWH-15-1-0693) Charnita Zeigler-Johnson, PHD Amy Leader, DRPH Division of Population Science Department of Medical Oncology Thomas Jefferson University Zeigler-Johnson
Prostate Cancer Rates (CDC 2011) Incidence Mortality Zeigler-Johnson
PA Cancer Registry Data 5-County Region (1995-2005) Geographical Patterns WHO: target where the most severe cases are WHY: associations with risk factors HOW: best way to intervene Prevention Detection Diagnosis Treatment Survivorship Zeigler-Johnson
EMPaCT Study Goal To develop a targeted educational intervention to increase knowledge about prostate cancer screening in high risk communities Novel Components: Transdisciplinary Team Mixed-methods approach used to develop the intervention Community risk determined by state cancer registry data Zeigler-Johnson
Aim 1a: Identifying High Risk Census Tracts for Prostate Cancer in Philadelphia (2005-2014 PA Cancer Registry) Aim 1b. Characterizing High Burden Census Tracts for Prostate Cancer in Philadelphia (2005-2014 PA Cancer Registry) Project Goals To describe patient and neighborhood characteristics of high burden census tracts To determine factors independently associated with high burden census tracts
Methods Dependent Variable Cancer Burden in the Census Tract Age-Standardized Incidence Rates (SIR) Age-Standardized Mortality Rates(SMR) Obtained Philadelphia prostate cancer dataset from the PA cancer registry (2005-2014, N=10802) Geocoded patient addresses at time of diagnosis (>95% geocoding success, N=10290) Census tract incidence and mortality rates determined Age-Standardized with national SEER data
Methods Dependent Variable Created 3 cancer burden groups using cut points (<1, 1) for SIR and SMR 1. Low (low SIR & low SMR) 2. Intermediate (high SIR & low SMR or low SIR & high SMR) 3. High (high SIR & high SMR) Majority of census tracts did not have overwhelmingly poor Pca outcomes
Methods -- Independent Variables Pennsylvania Cancer Registry (patient-level) Race Age Tumor stage and grade (aggressiveness) PSA at diagnosis U.S. Census Data 2010 (census tract level; quartiles) Household Income Percent Poverty
Demographics for Philadelphia, PA Cancer Registry (2005-2014) Variables All Cases N=10,290 Median age years 65 (range 31-103) Race White 33.5% Black 43.2% Hispanic 9% Other 14% Median PSA ng/ml 6.0 (range 0.1-98.0) Aggressive Tumor Localized stage & < 7 grade 43.8% Regional stage or 7 grade 43.2% Regional stage & 7 grade 9.2% Distant stage 3.4% Median Census Tract Income* US dollars 38,988 (range 19,696-102,336) Median Census Tract Poverty* % or residents 20.4% (range 0-83.2%) *2010 estimates from the American Community Survey
Demographics for Philadelphia by Prostate Cancer Burden Group, PA Cancer Registry (2005-2014) Variables Prostate Cancer Burden P-value Low (n=1838) Intermediate (n=5902) High (n=2550) Median age years 66 65 65 0.005 % Race/ ethnicity white 57.1 35.5 11.7 <0.001 black 17.8 40.5 67.9 Hispanic 8.8 9.0 9.8 other 16.3 14.9 10.6 % Aggressive tumor Localized stage & < 7 grade Regional stage or 7 grade Regional stage & 7 grade 48.1 44.0 40.4 <0.001 40.2 43.5 25.9 8.6 9.4 24.6 Distant stage 3.2 3.1 38.8 Median PSA ng/ml 5.6 6.0 6.4 <0.001 Median Census Tract Income Median Census Tract Poverty US dollars 43,990 40,727 35,200 <0.001 % of residents 17.2 18.7 30.6 <0.001
Variables Age Quartiles Associations with Neighborhood Prostate Cancer Burden (Low vs. Intermediate) (REF=31-57 years) Race (REF=Caucasian) Aggressiveness (REF=localized stage and <7 grade) OR (95% CI) 58-64 1.01 (0.84-1.21) 65-71 1.02 (0.85-1.23) 72-103 0.89 (0.73-1.08) African American 3.76 (3.17-4.47) Hispanic 1.73 (1.37-2.18) Other 1.25 (1.01-1.55) Regional stage or 7 grade 1.10 (0.96-1.26) Regional stage & 7 grade 1.03 (0.81-1.30) Distant stage 0.94 (0.61-1.46) PSA (per ng/ml) 1.00 (1.00-1.00) Median Census Tract Income (REF=$19696-$32533) 32596-38944 0.84 (0.68-1.04) 38988-47333 0.93 (0.75-1.15) 47750-102336 0.82 (0.67-1.02) Zeigler-Johnson
Variables Age Quartiles Associations with Neighborhood Prostate Cancer Burden (Low vs. High) (REF=31-57 years) Race (REF=Caucasian) Aggressiveness (REF=localized stage and <7 grade) OR (95% CI) 58-64 1.11 (0.86-1.43) 65-71 1.23 (0.95-1.60) 72-103 1.28 (0.98-1.69) African American 16.10 (12.96-20.00) Hispanic 4.51 (3.36-6.06) Other 2.44 (1.82-3.28) Regional stage or 7 grade 1.14 (0.94-1.38) Regional stage & 7 grade 0.96 (0.69-1.34) Distant stage 1.84 (1.05-3.23) PSA (per ng/ml) 1.00 (1.00-1.00) Median Census Tract Income (REF=$19696-32533) 32596-38944 0.43 (0.34-0.55) 38988-47333 0.20 (0.16-0.26) 47750-102336 0.17 (0.13-0.23) Zeigler-Johnson
Conclusions Non-clinical patient and neighborhood factors are associated with neighborhood prostate cancer burden Distant tumor stage is associated with high burden Targeted approaches may be used to decrease prostate cancer burden (mortality) More research is needed to understand the interaction of multilevel factors associated with prostate cancer This study using cancer registry data to identify high risk neighborhoods for prostate cancer provides a framework for studying cancer disparities
Acknowledgements Thomas Jefferson University Amy Leader, DrPH Scott Keith, PhD Russell McIntire, PhD University of Pennsylvania Karen Glanz, PhD
Questions? THANK YOU Zeigler-Johnson