Examining the Relationship between Residential History at Midlife and Prostate Cancer Outcomes

Prostate cancer (PCa) is one of a few cancers with more than double the mortality for black men, making this one of the greatest racial disparities in cancer. Although there are documented disparities in PCa incidence and mortality related to where people live, it is unclear how residential histories of patients contribute to their PCa outcomes. Residential environments vary greatly by race and socioeconomics (SES). Still little is known about how longitudinal exposures to neighborhood risk factors captured years before a cancer diagnosis and into survivorship contribute to PCa disparities along the cancer care continuum. Additionally, disease outcomes and disparities in PCa are moderated by patient age. Residential history during midlife is one of the factors that likely influences PCa incidence, progression, mortality, and overall care of survivors. We propose an innovative linkage of PA cancer registry data to hospital billing records from the Pennsylvania (PA) Healthcare Cost Containment Council and ~30 years of LexisNexis address data to provide characteristics of census tracts where patients live. We will use Pennsylvania (PA) Cancer Registry data (N~20,000 patients in Southeastern PA) to determine the relationship between longitudinal neighborhood characteristics (i.e., poverty trajectories) and PCa outcomes at critical points along the cancer care continuum. These various characteristics will be used to determine best practices to examine residential histories in risk modeling for PCa outcomes. We will take a novel life course approach to addressing the role of residential history on PCa disparities. We hypothesize that cumulative exposures as well as exposures to neighborhood risk factors during critical periods in the PCa care trajectory influence disease characteristics at diagnosis and PCa-mortality. Multilevel regression models will be conducted to evaluate independent associations of multi-level factors with PCa outcomes. We will also examine modification by age. The information that we learn from this study will help us to understand ways to integrate residential history into cancer research and identify effective interventions to promote prostate health among high-risk adult populations. We propose a longitudinal, ambidirectional study to address the following aims: Aim 1: To examine the relationships between PCa disparities and residential characteristics at diagnosis; Aim 2: To examine relationships between PCa disparities and accumulated residential history; Aim 3: To examine how residential exposures accumulated specifically during midlife are associated with PCa disparities; Aim 4: To conduct a community needs assessment in partnership with expert clinician and community members to improve PCa outreach and care.