Examining the Relationship Between Community History and Prostate Cancer Disparities
Abstract
Prostate cancer (PCa) mortality rates are twice as high for Black men, making this one of the greatest racial disparities in cancer. Where one lives impacts risk for advanced PCa and differentially impacts minority groups who are more likely to live in disadvantaged areas. Given that persistent health disparities are caused by social determinants experienced throughout one’s lifetime, evaluating the impact of policies that cause structural racism and poverty and influence community stability and investment needs to be included in cancer disparities research. The goal of this study is to learn how differential community investment over time is associated with disparities in prostate cancer care and outcomes. Research shows that disease rates vary by race, socioeconomics and geography and that different patterns of neighborhood disinvestment and reinvestment lead to dynamic neighborhood characteristics that can affect patient health, including cancer outcomes. Recent studies suggest that individuals who live in neighborhoods that have systematic lending biases, have been historically redlined or gentrified or have high levels of instability in residential tenure may be most likely to experience poor health outcomes, including cancer mortality. It is important to consider that not only do neighborhoods change over time, but also that patients change place of residence. Therefore, a comprehensive look at residential exposures over time and prior to cancer diagnosis is needed to understand how historical and long-term neighborhood exposures contribute to ongoing cancer disparities. This proposal addresses the Health Disparity Research Award Focus Area: Environmental Factors. In this proposed study, researchers will use a community history lens to examine where and why prostate cancer disparities exist. We expect to find that people who have lived in neighborhoods that experienced redlining, gentrification, and poverty will be more likely to experience poor prostate cancer outcomes. Using state cancer registry data linked to U.S. Census data and residential address data (available from LexisNexis), we will determine the neighborhood characteristics of where prostate cancer patients lived at diagnosis (2008-2018) and everywhere they lived over the 30 years prior to diagnosis. We will also use cancer registry data to follow the patients forward to determine which patients experience poor outcomes (high tumor stage or grade, delayed treatment outside of active surveillance, and mortality). This study will show us where in the care process neighborhood exposures make the most difference in prostate cancer outcomes (prior to diagnosis, during treatment, during survivorship) and suggest specific services, resources, and policies needed to decrease disparities. Most importantly, we will learn from 50 community members and 8 community leaders about how changes in neighborhood wealth, resources, amenities, and culture over time impacted their communities’ sense of power, autonomy, health, and prostate cancer care and outcomes, specifically. Our interviews with community members will also include an assessment of community strengths and weaknesses, as well as observed opportunities and threats to reducing prostate cancer disparities (SWOT analysis). This analysis will help us to develop a community-driven strategy to decrease prostate cancer disparities. It will also increase the cultural acceptance and likelihood of success of future research and interventions targeting these high-risk communities. Impact: This innovative study will advance the field of prostate cancer research by illuminating (1) the connection between the residential environment and prostate cancer care and outcomes, (2) how community members perceive lasting health impacts from their community’s history, and (3) unique barriers to timely prostate healthcare and opportunities to reduce morbidity and mortality disparities in communities with the high
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210290
Entities
People
- Charnita M Zeigler-Johnson
Organizations
- Thomas Jefferson University
- United States Army