ASCO GU 2023: Socioeconomic Vulnerability and the Risk of Genitourinary Cancer Mortality Among United States Counties

( On the second day of the American Society for Clinical Oncology (ASCO) Genitourinary Cancer Symposium 2023 focussing on urothelial cancer, the Poster Session B: Prostate Cancer and Urothelial Carcinoma included a presentation from Dr. Anum Riaz discussing the association between socioeconomic vulnerability and the risk of genitourinary cancer malignancy in the United States.

While socioeconomic status has clearly recognized effects on general health outcomes and health care access, the association with genitourinary (GU) cancer mortality in the United States (US) remains unclear. The authors of this analysis sought to address this knowledge gap.

To do so, the authors abstracted county-level age-adjusted mortality rates (AAMR) per 100,000 person-years (PY) for populations diagnosed with GU cancers from the wide-ranging online data for epidemiological research (WONDER) database. The agency for toxic substances and disease registry (ATSDR) was used to obtain county-level social vulnerability indices from 2014-2018. The authors ranked each US county based on a percentile ranking score (PRS: ranging from 0-1) which were further categorized into quartiles (1st: 0-0.25 [least vulnerable]; 4th: 0.75-1.00 [most vulnerable]).

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The authors then assessed the association between AAMRs and quartile rankings. They used a population-weighted, Poisson regression analysis to compute rate ratios (RR) of AAMRs between 4th and 1st quartile with the corresponding 95% confidence intervals (CI).

The authors examined 3142 US counties with an AAMR for GU cancers of 22.6 overall deaths (OD) and 4.20 premature deaths (PD; defined as death at age <65 years) per 100,000 PY. GU cancer-related mortality increased in a stepwise fashion from the 1st quartile to the 4th quartile (OD: 21.6 vs 24.1; PD: 3.48 vs 5.19). In terms of overall deaths by specific GU cancers, significantly higher AAMRs were observed in the 4th quartile compared to the 1st quartile for patients with prostate cancer (RR; 1.19 [95% CI;1.14-1.24]), and renal cell carcinoma (RCC; 1.12 [1.04-1.21]) but not for those with lower urothelial tract cancers (0.92 [0.87-0.96]). Among subgroups, non-Hispanic Blacks (1.19 [1.07-1.33]), and Hispanics (1.28 [1.08-1.51]) with prostate cancer and men with RCC (1.11; 1.03-1.19) in the 4th quartile experienced significantly higher overall mortality when compared to those in the 1st quartile.

In terms of premature death, significantly higher AAMRs were observed in the 4th quartile vs 1st quartile for patients with prostate cancer (1.54 [1.34-1.77]), and RCC (1.28 [1.12-1.45]). Consistently, men with RCC in the 4th quartile also experienced higher premature mortality when compared to the 1st quartile.

Unfortunately, a sparsity of mortality data among different ethnic/racial subgroups precluded any formal assessment of race-based disparities in specific GU cancers. Further sensitivity analysis using a weighted linear regression showed consistent results.

Thus, the authors conclude that these population level data demonstrate that socially vulnerable populations, especially Non-Hispanic Black and Hispanic men with prostate cancer and men with renal cell carcinoma, may be at an increased risk of cancer-related mortality. Therefore, there is a pressing need to address this mortality gap across different socioeconomic subgroups to ensure health-care equity.

Presented by: Anum Riaz, MBBS, University of Arizona Department of Medicine, Tucson, Arizona