Racial disparities in prostate cancer mortality: a model-based decomposition of contributing factors

Abstract

To investigate the relative contributions of natural history and clinical interventions to racial disparities in prostate cancer mortality in the United States, we extended a model that was previously calibrated to Surveillance, Epidemiology, and End Results (SEER) incidence rates for the general population and for Black men. The extended model integrated SEER data on curative treatment frequencies and cancer-specific survival. Starting with the model for all men, we replaced up to 9 components with corresponding components for Black men, projecting age-standardized mortality rates for ages 40-84 years at each step. Based on projections in 2019, the increased frequency of developing disease, more aggressive tumor features, and worse cancer-specific survival in Black men diagnosed at local-regional and distant stages explained 38%, 34%, 22%, and 8% of the modeled disparity in mortality. Our results point to intensified screening and improved care in Black men as priority areas to achieve greater equity.

Figure 1.

A) Age-standardized prostate cancer incidence rates per 100 000 for all men and for Black men aged 40-84 years at diagnosis from the Surveillance, Epidemiology, and End Results (SEER) program (data from the core 9 registries for 1975-2018 and from the core 8 registries after Detroit was removed for 2019) and corresponding model-projected incidence rates after sequentially replacing components for all men with components for Black men. B) Age-standardized prostate cancer mortality rates per 100 000 for all men and for Black men aged 40-84 years at death from the National Center for Health Statistics (NCHS) and corresponding model-projected mortality rates after sequentially replacing components for all men with components for Black men.