Epidemiological Determinants of Advanced Prostate Cancer in Elderly Men in the United States

In this study, we examined the effects of individual-level and area-level characteristics on advanced prostate cancer diagnosis among Medicare eligible older men (ages 70+ years). We analyzed patients from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2000-2007) li...

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Bibliographic Details
Published in:Clinical Medicine Insights. Oncology Vol. 13; p. 1179554919855116
Main Authors: Jayasekera, Jinani, Onukwugha, Eberechukwu, Cadham, Christopher, Tom, Sarah, Harrington, Donna, Naslund, Michael
Format: Journal Article
Language:English
Published: London, England SAGE Publications 2019
Sage Publications Ltd
SAGE Publishing
Subjects:
Beneficiaries
Censuses
Comorbidity
Disease prevention
Enrollments
Epidemiology
Health behavior
Health maintenance organizations
Health services
HMOs
Medical diagnosis
Medical screening
Medicare
Metastasis
Older people
Original Research
Prostate cancer
Socioeconomic factors
Surveillance
United States > US
stage at diagnosis
geographic disparities
health services supply index
prostate cancer screening
socioeconomic status index
ISSN:1179-5549, 1179-5549
Online Access:Get full text
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Summary:In this study, we examined the effects of individual-level and area-level characteristics on advanced prostate cancer diagnosis among Medicare eligible older men (ages 70+ years). We analyzed patients from the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database (2000-2007) linked to US Census and County Business Patterns data. Cluster-adjusted logistic regression models were used to quantify the effects of individual preventive health behavior, clinical and demographic characteristics, area-level health services supply, and socioeconomic characteristics on stage at diagnosis. The fully adjusted model was used to estimate county-specific effects and predicted probabilities of advanced prostate cancer. In the adjusted analyses, low intensity of annual prostate-specific antigen (PSA) testing and other preventive health behavior, high comorbidity, African American race, and lower county socioeconomic and health services supply characteristics were statistically significantly associated with a higher likelihood of distant prostate cancer diagnosis. The fully adjusted predicted proportions of advanced prostate cancer diagnosis across 158 counties ranged from 3% to 15% (mean: 6%, SD: 7%). County-level socioeconomic and health services supply characteristics, individual-level preventive health behavior, demographic and clinical characteristics are determinants of advanced stage prostate cancer diagnosis among older Medicare beneficiaries; other health care-related factors such as family history, lifestyle choices, and health-seeking behavior should also be considered as explanatory factors.
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Deceased March 30, 2018.
ISSN:1179-5549
1179-5549
DOI:10.1177/1179554919855116