Racial Disparities in Prostate Cancer Mortality in the 50 Largest US Cities

Abstract

Introduction: This paper presents race-specific prostate cancer mortality rates and the corresponding disparities for the largest cities in the US over two decades.

Methods: The 50 largest cities in the US were the units of analysis. Data from two 5-year periods were analyzed: 1990-1994 and 2005-2009. Numerator data were abstracted from national death files where the cause was malignant neoplasm of prostate (prostate cancer) (ICD9=185 and ICD10=C61). Population-based denominators were obtained from US Census data. To measure the racial disparity, we calculated non-Hispanic Black: non-Hispanic White rate ratios (RRs), rate differences (RDs), and corresponding confidence intervals for each 5-year period. We also calculated correlation and unadjusted regression coefficients for 11 city-level variables, such as segregation and median income, and the RDs.

Results: At the final time point (2005-2009), the US and all 41 cities included in the analyses had a RR greater than 1 (indicating that the Black rate was higher than the White rate) (range=1.13 in Minneapolis to 3.24 in Los Angeles), 37 of them statistically significantly so. The US and 26 of the 41 cities saw an increase in the Black:White RR between the time points. The level of disparity within a city was associated with the degree of Black segregation.

Conclusion: This analysis revealed large disparities in Black:White prostate cancer mortality in the US and many of its largest cities over the past two decades. The data show considerable variation in the degree of disparity across cities, even among cities within the same state. This type of specific city-level data can be used to motivate public health professionals, government officials, cancer control agencies, and community-based organizations in cities with large or increasing disparities to demand more resources, focus research efforts, and implement effective policy and programmatic changes in order to combat this highly prevalent condition.

Keywords: Big cities; Epidemiology; Mortality; Prostate cancer; Racial disparities.