Abstract
Abstract
Background
Spatial heterogeneity of prostate cancer-specific mortality in Pennsylvania remains unclear. We utilized advanced geospatial survival regressions to examine spatial variation of prostate cancer-specific mortality in PA and evaluate potential effects of individual- and county-level risk factors.
Methods
Prostate cancer cases, aged ≥40 years, were identified in the 2004–2014 Pennsylvania Cancer Registry. The 2018 County Health Rankings data and the 2014 U.S. Environmental Protection Agency’s Environmental Quality Index were used to extract county-level data. The accelerated failure time models with spatial frailties for geographical correlations were used to assess prostate cancer-specific mortality rates for Pennsylvania and by the Penn State Cancer Institute (PSCI) 28-county catchment area. Secondary assessment based on estimated spatial frailties was conducted to identify potential health and environmental risk factors for mortality.
Results
There were 94,274 cases included. The 5-year survival rate in PA was 82% (95% confidence interval, CI: 81.1–82.8%), with the catchment area having a lower survival rate 81% (95% CI: 79.5–82.6%) compared to the non-catchment area rate of 82.3% (95% CI: 81.4–83.2%). Black men, uninsured, more aggressive prostate cancer, rural and urban Appalachia, positive lymph nodes, and no definitive treatment were associated with lower survival. Several county-level health (i.e., poor physical activity) and environmental factors in air and land (i.e., defoliate chemical applied) were associated with higher mortality rates.
Conclusions
Spatial variations in prostate cancer-specific mortality rates exist in Pennsylvania with a higher risk in the PSCI’s catchment area, in particular, rural-Appalachia. County-level health and environmental factors may contribute to spatial heterogeneity in prostate cancer-specific mortality.
Funder
National Center for Advancing Translational Sciences
Highmark Incorporation Grant
National Institute of Environmental Health Sciences
Publisher
Springer Science and Business Media LLC
Subject
Cancer Research,Genetics,Oncology
Cited by
4 articles.
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