Pd40-07 Disparities in Prostate Cancer Mortality and Clinical Trial Availability Across Vulnerable Populations

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making III (PD40)1 May 2024PD40-07 DISPARITIES IN PROSTATE CANCER MORTALITY AND CLINICAL TRIAL AVAILABILITY ACROSS VULNERABLE POPULATIONS Rishi Sekar, Kristian Stensland, and Lindsey Herrel Rishi SekarRishi Sekar , Kristian StenslandKristian Stensland , and Lindsey HerrelLindsey Herrel View All Author Informationhttps://doi.org/10.1097/01.JU.0001009356.04608.d5.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Adverse social determinants of health (SDOH) may underlie disparities in cancer mortality and access to clinical trials. Identifying and overcoming these barriers is essential for the delivery of equitable cancer care. For these reasons, we evaluate the association between clinical trial availability, cancer mortality, and population-level social determinants of health in prostate cancer (PCa). METHODS: Using data linkage from ClinicalTrials.gov, Surveillance Epidemiology and End Results (SEER) Registry, and the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), we performed a cross-sectional analysis of county-level PCa clinical trial availability, PCa incidence and mortality rates, and population-level SDOH. We included Phase 2 and Phase 3 interventional PCa clinical trials (2007 to 2022). Trial availability was defined as the presence of any PCa trial in a county over the study period. Counties were stratified into quintiles of SVI (i.e., least vulnerable to most vulnerable). Trial availability, PCa incidence, and PCa mortality were compared across SVI quintiles. Multivariable logistic and linear regression analyses were performed to evaluate the association between SVI and trial availability and PCa mortality, respectively. RESULTS: Of the 3,142 counties included in the analysis, 1,310 (41.7%) had any PCa trial, with the most vulnerable counties having a lower proportion compared to the least vulnerable counties (27.9% vs. 46.9%, p<0.05). Further, the most vulnerable counties had a lower PCa incidence rate (mean 393.8 vs. 411.7, p<0.05), but a higher PCa mortality rate (mean 85.7 vs. 72.0, p<0.05). On adjusted analysis, the most vulnerable counties were associated with decreased odds of having any trial (OR 0.3, 95% CI 0.2–0.4) and increased PCa mortality (10.8, 95% CI 7.4–14.3), while the presence of any trial was associated with decreased PCa mortality (-6.9, 95% CI -9.1– -4.7). CONCLUSIONS: The most vulnerable counties were far less likely to have any PCa trials despite having a significantly higher PCa mortality rate. The presence of a trial was associated with a reduction in mortality, perhaps representing better developed cancer care infrastructure. These vulnerable counties represent scientifically underserved populations that may benefit from equity-driven expansion of cancer care infrastructure. Source of Funding: Rishi Sekar received research support from the National Cancer Institute institutional training grant T32-CA-236621 © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e822 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Rishi Sekar More articles by this author Kristian Stensland More articles by this author Lindsey Herrel More articles by this author Expand All Advertisement PDF downloadLoading ...