Area-level Incarceration as a Driver of Prostate Cancer Mortality and Disparities in Georgia Open Access

Abstract

Introduction: Prostate cancer is the most prevalent non-epidermal cancer among American men, with an estimated 191,930 new cases and 33,000 deaths expected in 2020. In this study, we aim to examine the association between area-level incarceration and prostate cancer mortality rates across the state of Georgia where incarceration rates are 4th in the nation.

Methods: The data was obtained from Surveillance, Epidemiology, and End Results (SEER). The study population was (n=65536), but after inclusion criteria (n=42215). Cox proportional hazard models and polytomous logistic regression were used.

Results: The overall association between incarceration and prostate cancer mortality was HR=2.60; 95% CI=0.86-1.07). Stratum specific hazard ratios for the association between area-level incarceration and prostate cancer mortality for non-Hispanic Black vs. White men was 1.61 (95% CI=1.37-1.40) in areas of low incarceration and 2.03 (95% CI=1.74-2.36) in areas of high incarceration (defined as greater than the average rate). After accounting for covariates, the disparity in high incarceration areas was attenuated (HR=1.65; 05% CI=1.38-1.97). Incarceration was associated with development of stage III (vs. stage I) tumors (OR=1.18; 95% CI=1.07-1.31) and tumors that were undifferentiated (vs. well-differentiated) (OR=1.10; 95% CI=1.03-1.19).

Conclusion: Incarceration was associated with increased mortality from prostate cancer. The race mortality disparity was most pronounced in areas of high incarceration but appear to be largely due to tumor and other neighborhood characteristics.

 

 

Table of Contents

CHAPTER I: BACKGROUND/LITERATURE REVIEW ................................ 1

1.1 Incidence of Prostate Cancer ..........................................................................1

1.2 Risk Factors of Prostate Cancer......................................................................1

1.3 Disparities   ...................................................................................................1

1.4 Area level Incarceration  ................................................................................2

1.5 Pathophysiology ..............................................................................................2

1.5 Mechanism of Stressors ..................................................................................3

1.6  Aims of Thesis ...............................................................................................3

 

CHAPTER II: AREA-LEVEL INCARCERATION AS A DRIVER OF PROSTATE CANCER MORTALITY IN GEORGIA ...............................................................................4

1.7 Abstract ............................................................................................................4

1.8 Introduction .....................................................................................................5

1.9 Methods............................................................................................................8

2.0 Results ............................................................................................................10

2.1 Discussion ......................................................................................................11

2.2 REFERENCES ................................................................................................15

2.3 TABLES ...........................................................................................................17

CHAPTER III: PUBLIC HEALTH IMPLICATIONS, DAG, AND LITERATURE REVIEW..................................................................................................................21

2.4 Appendices ........................................................................................................21

2.5 Appendix A .......................................................................................................21

2.6 Appendix B .......................................................................................................22

2.7 Appendix C ........................................................................................................23

 

 

 

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology Health Sciences, Public Health
Keyword	Social economic factors Prostate cancer disparity Incarceration and health Neighborhood factors and public health
Committee Chair / Thesis Advisor	McCullough, Lauren, Emory University

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	SAS codes and table (Sas codeas used during the statistical analysis.It shows how the data was cleaned, and all regression analysis methods used. The table is the early version of one of the tables used .)	2021-04-20 15:16:19 -0400	Press to Select an action Download