Real-world assessment of the impact of neighborhood vulnerabilities on prostate cancer outcomes in the Medstar Health Network.

Abstract

e17140 Background: The disparities in prostate cancer (PC) treatment outcomes are thought to be multifactorial, resulting from complex interactions between social determinants of health (SDoH), disease biology, and healthcare-related factors. The impact of SDoH on PC mortality remains unclear. This study examines whether equal access to standard of care eliminates outcome disparities among men with advanced PC in the Medstar Health Network. Methods: This is a retrospective analysis of factors associated with treatment outcomes among men with advanced PC who received standard of care treatment in the Medstar Health Network from 2014-2025. Social Vulnerability Index (SVI) was used as a validated tool to quantify patients’ vulnerabilities. We compared age, disease stage at diagnosis, mortality between the highest (Q4) and lowest (Q1) vulnerability quartiles and between racial groups using chi-squared tests and t-tests. Results: We identified a cohort of 360 men diagnosed with PC which included 166 (46.1%) Black and 139 (38.6%) White patients. Median age was 73 years (IQR 66-80). Staging data were available for 281 patients, with 215 (78%) initially diagnosed with stage IV disease. SVI data were collected for 324 (90%) patients and Gleason scores were available for 239 (66.4%) patients. Median treatment follow-up was 26 months (IQR 10.8-53.7). A total of 116 patients (32.8%) died. SVI and outcomes: Significant differences were observed between Q1 and Q4 groups in stage IV diagnosis rates (Q4 areas 85% vs Q1 areas 64.7%, p = 0.012, OR = 3.21). However, mortality was equivalent between groups (32.1% vs 34.6%, p = 0.87) as was age at diagnosis (70.8 vs 72.3 years, p = 0.30). Race and Outcomes: Stage IV diagnosis rates were similar between Black and White patients (77.7% vs 72.3%, p = 0.41). However, Black patients were diagnosed significantly younger (mean age 70.3 vs 74.6 years, p = 0.0001), with a mean difference of 4.3 years. Mortality rates were comparable (33.3% vs 37.2%, p = 0.56). Black patients resided in significantly more disadvantaged areas (mean SVI 0.545 vs 0.316, p = 0.0001). Conclusions: Among patients treated at the Medstar Health Network, there were significant racial disparities in age at diagnosis, whereas patients in disadvantaged areas were more likely to be diagnosed with stage IV disease. However, no significant differences in mortality were observed by race or SVI. These findings suggest that equitable access to high-quality care may mitigate outcome disparities despite persistent contextual disadvantages. This dataset has limitations related to its retrospective nature and its limited sample size. However, these results are consistent with prior studies that demonstrate similar outcomes between populations when patients receive standard of care. This study adds rationale to promote health equity, ensuring broader access to screening and treatment to minority populations.