Disparities in Prostate Cancer Specific Mortality in Incarcerated vs. Non-Incarcerated Patients in Michigan: A Statewide Retrospective Cohort Study.

Abstract

Introduction: With rising incarceration and cancer diagnosis rates in the US, understanding the relationship between incarceration status and cancer outcomes is critical. Our study examined prostate cancer specific mortality (PCSM) disparities in incarcerated patients (IP) vs. non-incarcerated patients (NP) in Michigan.

Methods: The Michigan Department of Health & Human Services Database (MDHHS) was screened for prostate cancer (PCa)(Histology=8140) diagnosed patients between 2004-2015. IP and NP were cross-analyzed with demographic and clinical covariates. The cumulative incidence function (CIF) and competing risks multivariable regression were used to examine incarceration impact on PCSM after accounting for all covariates.

Results: In our cohort of 76,045 patients, 152 were IP. Compared to NP, IP were more likely to be younger (median 58.0 years vs. 67.0 years) and non-hispanic black (NHB)(65.8% vs. 16.0%), both p<0.0001. IP had higher probability to be diagnosed with ≤cT2 PCa (95.3% vs. 88.5%;p<0.0001), cN0 PCa (94.1% vs. 86.8%;p<0.01), and undergo surgery as first course treatment (31.6% vs. 24.4%;p=0.02). Compared to NP, no difference was found in gleason grade ≥8 (52.6% vs. 51.4%;p=0.9) and PSA (median 7.5 vs. 5.9;p=0.6). At 10 years, PCSM was 14.7% (95% CI:7.0%-25.0%) in IP vs. 11.4% (95% CI:11.1%-11.7%) in NP (p=0.2). At the multivariable analysis, IP had a 2.44 fold (95% CI:1.53-3.88;p<0.001) higher PCSM risk than NP.

Conclusion: Despite being diagnosed with PCa at a younger age and an earlier stage, IP showed a higher PCSM risk than NP. Further research is warranted to examine this difference.