Race, neighborhood deprivation, and mortality in prostate cancer: A real-world analysis from the MedStar Health Network.

e17137 Background: The Area Deprivation Index (ADI), a validated measure of neighborhood socioeconomic disadvantage, demonstrates race-specific associations with prostate cancer (PC) risk. Studies have shown neighborhood deprivation independently increases PC risk and mortality among Black men, a relationship not observed in White men. We evaluated the associations between race, ADI, and all-cause mortality among men with prostate cancer within the MedStar Health Network. Methods: This is a retrospective cohort study of 4115 PC patients (46.1% Black, 40.4% White, and 13.5% Other) within the MedStar Health Network (2016-2024). Each patient was assigned an ADI score based on their residential zip code that was ranked relative to the national level and further categorized into quartiles. Chi-square tests were used to assess associations between race and ADI quartile (Q1 = least deprived and Q4 = most deprived), including pairwise comparisons between racial groups. Multivariable logistic regression models, including an interaction term between race and ADI, were used to assess differential associations with mortality. Results: We included 1973 patients in the analysis (41.6% Black, 44.5% White, and 14.0% Other) residing in Q1 (53.4%) and Q4 (46.6%). There was a significant association between race and ADI (χ² p < 0.001) with Black patients disproportionately represented in Q4. Pairwise comparisons demonstrated significant differences between Black versus White patients (p < 0.001) and Black versus Other patients (p < 0.001), while White versus Other patients did not differ significantly (p = 0.473). In multivariable logistic regression, residence in Q4 was independently associated with higher odds of mortality (OR 1.45, 95% CI 1.17–1.79, p < 0.001). When stratified by race, race was not significantly associated with mortality among Black (OR 1.17, p = 0.333), White (OR 1.55, p = 0.055) or Other (OR 0.99, p = 0.976) patients in Q4. Conclusions: We found that Black men with PC are disproportionately represented in the most deprived ADI quartile (Q4) compared to White Men. While residence in the most disadvantaged neighborhoods was independently associated with higher odds of mortality in the cohort, this association did not reach statistical significance within individual racial groups. This outcome contrasts prior studies that show neighborhood deprivation is associated with increased all-cause mortality specifically within Black men. Our findings suggest that neighborhood deprivation contributes to PC mortality disparities through complex mechanisms that extend beyond race alone. Targeted interventions addressing neighborhood-level socioeconomic disadvantage may help reduce disparities in prostate cancer outcomes across all racial groups.