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. 2024 Oct 2;33(10):1318-1326.
doi: 10.1158/1055-9965.EPI-24-0450.

Neighborhood Disadvantage and Prostate Tumor Aggressiveness among African American and European American Men

Joseph Boyle  1   2 , Jessica Yau  3 , Jimmie L Slade  4 , Derrick A Butts  5 , Jessica Wimbush  6 , Jong Y Park  7 , Arif Hussain  8   9   10 , Eberechukwu Onukwugha  10   11 , Cheryl L Knott  10   12 , David C Wheeler  1   2 , Kathryn Hughes Barry  10   13
Affiliations

Neighborhood Disadvantage and Prostate Tumor Aggressiveness among African American and European American Men

Joseph Boyle et al. Cancer Epidemiol Biomarkers Prev. .

Abstract

Background: Studies have identified associations between neighborhood disadvantage (ND), which is more likely to affect African American (AA) individuals, and aggressive prostate cancer. Thus, ND may contribute to prostate cancer disparities. However, it is unknown what ND components drive aggressive disease and whether associations vary by race.

Methods: We evaluated associations between aggressive prostate cancer and four ND metrics-Area Deprivation Index (ADI), validated Bayesian Neighborhood Deprivation Index (NDI), racial isolation (RI) index, and historical redlining, and whether these factors interacted with race, among men with prostate cancer treated at the University of Maryland Greenebaum Comprehensive Cancer Center (2004-2021).

Results: We included 1,458 men (698 European American and 760 AA). AA men were more likely to experience ND. In adjusted models, the ADI, RI, and redlining were significantly associated with aggressive versus nonaggressive prostate cancer overall [ADI, OR for one SD increase = 1.14, 95% confidence interval (CI), 1.00-1.30; RI, OR = 1.27, CI, 1.07-1.51; redlining, OR = 1.77; CI, 1.23-2.56] and among AA men. The NDI was associated with aggressive prostate cancer among AA men (OR = 1.32, 95% credible interval: 1.13-1.57); percent in poverty received the largest importance weight. The ADI (P heterogeneity = 0.002) and NDI (exceedance probability heterogeneity = 98.1%) significantly interacted with race, such that associations were significantly stronger for AA men.

Conclusions: We identified novel significant positive associations for racial segregation and historical redlining with aggressive prostate cancer and significant interactions between ND indices and race.

Impact: Findings inform specific ND components that are associated with aggressive prostate cancer and suggest the ND effect is stronger for AA men, which has implications for interventions to reduce disparities.

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Conflict of interest statement

Conflict of Interest: The authors declare no potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Values of Area Deprivation Index (ADI) for participants with residential addresses in the city of Baltimore, Maryland. The mean value of the ADI is scaled to be 100, with larger values indicating greater deprivation. Residential locations have been randomly jittered to maintain confidentiality.
Figure 2.
Figure 2.
Estimated importance weights in Neighborhood Deprivation Index in model with only African American participants. The weights are between 0 and 1 and sum to 1.
Figure 3.
Figure 3.
Values of Racial Isolation Index (RI) for participants with residential addresses in the city of Baltimore, Maryland. The RI Index is between 0 and 1, with larger values indicating a greater degree of African American residential segregation. Residential locations have been randomly jittered to maintain confidentiality.
Figure 4.
Figure 4.
Neighborhood grades from HOLC redlining map for participants in the city of Baltimore, Maryland. Grades of “D” indicate redlined neighborhoods. Residential locations have been randomly jittered to maintain confidentiality.
See this image and copyright information in PMC

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