Psychosocial factors and overall mortality after prostate cancer diagnosis among predominantly low-income Black and White adults.

Abstract

Introduction: Psychosocial factors may influence PCa survival, but evidence is limited for low-income populations.

Methods: This study utilized data from the Southern Community Cohort Study (SCCS), a prospective cohort of ∼85,000 individuals aged 40 to 79, from predominantly low-income backgrounds, enrolled between 2002 to 2009 across 12 southeastern states. A total of 1,367 men (1,058 Black and 309 White) found with PCa during the follow-up of 34,313 men were included. The Kaplan-Meier method was used to generate 5-year survival rates with log-rank tests for statistical significance. Multivariable Cox models were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for psychosocial-mortality associations.

Results: Over 18-years of follow-up, 291 Black (27.5%) and 59 White (19.1%) PCa patients died (P=0.03). White men self-reporting major depressive symptoms and their inability to control important things in life (ITC) had an 11% (Psurvival = 0.01) and 12% (Psurvival = 0.01) lower 5-year survival compared to those that didn't, with aHR of 2.56, (95% CI = 1.13-5.77) and 2.30 (95% CI = 1.07-4.95), respectively. Inverse associations were found for per SD increase in depression score (aHR = 0.84, 95%CI = 0.74-0.96.) among black patients. Testing for multiplicative interaction was significant for race-depression (Pinteraction = 0.02) and race-ITC (Pinteraction 0.04). The associations were mainly seen among PCa cases diagnosed within 5 years after baseline survey.

Conclusion: Psychosocial-mortality associations among PCa patients are complex and may not affect individuals equally. Programs aiming to reduce mortality for individuals with PCa should consider their psychosocial needs and demographic background.