Socioenvironmental adversity and risk of prostate cancer in non-Hispanic black and white men

Abstract

Non-Hispanic black (NHB) men experience higher risk of prostate cancer than other racial/ethnic groups, and it is possible that socioenvironmental (SE) adversity and resulting stress may contribute to this disparity. Data from the Southern Community Cohort Study were used to evaluate associations between SE adversity and perceived stress in relation to prostate cancer risk, overall and by race/ethnicity and grade. Between 2002 and 2009, 26,741 men completed a questionnaire, from which an 8-item SE adversity composite was created (covering socioeconomic status, residential environment, and social support/buffers). Two items from the Perceived Stress Scale were assessed. With follow-up through 2011, 527 prostate cancer cases were diagnosed. In multivariable models, each one-unit increase in the SE adversity composite was associated with increased prostate cancer risk among non-Hispanic white (NHW) men (HR 1.23; 95% CI 1.02-1.48) and reduced risk among NHB men (HR 0.89; 95% CI 0.82-0.95) (p interaction: 0.001). This pattern held for low grade, but not high grade, cancers although power was limited for the latter. Perceived stress variables were associated with increased risk of prostate cancer among NHW men, but not among NHB men. Results do not support the hypothesis that SE adversity my underlay the racial disparity in prostate cancer, over and above that of covariates, including healthcare utilization.

Keywords: African Americans; Life stress; Minority health; Prostate cancer; Psychological stress.

Figure 1.

Socioenvironmental (SE) adversity and risk of prostate cancer, by grade and race/ethnicity. The left side of the figure shows the hazard ratios and corresponding 95% CIs for the associations between the SE adversity composite and high-grade prostate cancer, stratified by race/ethnicity. Results are presented for low-grade prostate cancer in the right column. The SE adversity composite ranges from 0-8, with 1 point given for each of the following 8 SE adversities: divorced, separated or widowed, uninsured, lack of faith or comfort from God, no one to help in an emergency, low education, low income, higher crime in neighborhood, and high Neighborhood Deprivation Index. Results are adjusted for the following: age, race, time since last doctor visit, family history of prostate cancer, history of digital rectal exam, and history of prostate specific antigen screening.