ABSTRACT
Prostate cancer (PCa) is one of a few cancers with more than double the mortality for black men, making this
one of the greatest racial disparities in cancer. Although there are documented disparities in PCa incidence
and mortality related to where people live, it is unclear how residential histories of patients contribute to their
PCa outcomes. Residential environments vary greatly by race and socioeconomics (SES). Still little is known
about how longitudinal exposures to neighborhood risk factors and structural racism captured years before a
cancer diagnosis and into survivorship contribute to PCa disparities along the cancer care continuum.
Additionally, disease outcomes and disparities in PCa are moderated by patient age. Residential history
during midlife is one of the factors that likely influences PCa incidence, progression, mortality, and overall care
of survivors. We propose an innovative linkage of PA cancer registry data to hospital billing records from the
PA Healthcare Cost Containment Council and ~30 years of LexisNexis address data to provide characteristics
of census tracts where patients live. We will use Pennsylvania (PA) Cancer Registry data (N~20,000 patients
in Southeastern PA) to determine the relationship between longitudinal neighborhood characteristics (poverty
trajectories, historical redlining, lending bias, and gentrification) and PCa outcomes at critical points along the
cancer care continuum in a diverse and historic region. These various characteristics will be used to determine
best practices to examine residential histories in risk modeling for PCa outcomes. We will take a novel life
course approach to addressing the role of residential history on
PCa disparities. We hypothesize that cumulative exposures as well
as exposures to neighborhood risk factors during critical periods in
the PCa care trajectory influence disease characteristics at
diagnosis and PCa-mortality. Multilevel regression models will be
conducted to evaluate independent associations of multi-level
factors with PCa outcomes. We will also examine modification by
age. The information that we learn from this study will help us to
understand ways to integrate residential history in cancer research
and strategize about effective interventions to promote prostate
health among high-risk adult populations
We propose a longitudinal, ambidirectional study to address the
following aims: Aim 1: To examine the relationships between PCa
disparities and residential characteristics at diagnosis; Aim 2: To We will employ a life-course framework in this
examine relationships between PCa disparities and accumulated cancer disparities research (based on Ory, et al.
residential history; Aim 3: To examine how residential exposures 2014, AJPM). Disparities occur within an
accumulated specifically during midlife are associated with PCa environmental context. Research focused on
disparities; Aim 4: Conduct a community needs assessment in particular life stages provide unique opportunities
partnership with expert clinician and community planning stakeholders to inform policy, practice, and the health of the
to improve PCa outreach and care community.
