Social determinants of health and long-term outcomes in prostate cancer: Mortality, survival, and comorbidity risks in a propensity score–matched federated database analysis.

Abstract

12119 Background: Social determinants of health (SDOH) such as housing instability, food insecurity, and low income are known to influence health outcomes, but their long-term effects on prostate cancer (PCa) patients remain underexplored. To compare long-term outcomes, including mortality, sepsis, sexual dysfunction, and comorbidities across major organ systems, between prostate cancer patients with and without adverse SDOH. Methods: Retrospective cohort study using the TriNetX federated database (deprecated COVID-19 Research Network, 88 healthcare organizations). Cohort 1 included adults (≥18 years) with PCa (ICD-10-CM C61) and at least one adverse SDOH code (n = 14,595). Cohort 2 included PCa patients without SDOH codes (n = 875,545). Propensity score matching (1:1) balanced cohorts on demographics, external morbidity causes, ECOG status, and BMI (final n = 12,626 per cohort). The index event was the first prostate cancer diagnosis (with SDOH for Cohort 1). Outcomes assessed from 1-day post-index onward (up to 20 years prior exclusion). Risk ratios (RR), hazard ratios (HR) from Kaplan-Meier survival, and mean instances via t-tests for mortality, severe sepsis, sexual dysfunction, and diseases of genitourinary, circulatory, endocrine/metabolic, respiratory, digestive, and infectious systems. Results: After matching, cohorts were balanced (mean age ~72 years, ~56% White, ~25% Black). PCa with adverse SDOH had higher mortality risk (22.0% vs 17.3%; RR 1.272 [95% CI, 1.209-1.338]; p < 0.001) and worse survival (median 2821 vs 5246 days; HR 2.018 [95% CI, 1.906-2.137]; p < 0.001). Severe sepsis risk was elevated (5.6% vs 4.7%; RR 1.199 [95% CI, 1.074-1.339]; p < 0.001; HR 1.824 [95% CI, 1.626-2.047]; p < 0.001). Sexual dysfunction risk was lower (0.2% vs 0.4%; RR 0.493 [95% CI, 0.305-0.794]; p = 0.003). For comorbidities, PCa with adverse SDOH showed mixed risks—genitourinary diseases had a lower risk but poorer survival (HR 1.113, 95% CI 1.017-1.218, p = 0.020); circulatory diseases showed equivalent risk but worse survival (HR 1.223, 95% CI 1.089-1.374, p = 0.001); endocrine/nutritional/metabolic conditions had similar risk but reduced survival (HR 1.277, 95% CI 1.151-1.418, p < 0.001); respiratory diseases had equivalent risk but poorer survival (HR 1.531, 95% CI 1.416-1.656, p < 0.001); digestive diseases demonstrated lower risk with worse survival (HR 1.308, 95% CI 1.200-1.425, p < 0.001). Conclusions: Adverse SDOH are associated with increased mortality and poorer survival in prostate cancer, alongside heightened sepsis risk and differential comorbidity patterns. Interventions targeting SDOH may improve long-term outcomes.