Presentations

Abstract

Introduction: Social Vulnerability (SV) encompasses several factors used to identify communities at greater disadvantage, and that may experience a greater burden of comorbidities and detrimental health-related behaviors. In men with Prostate Cancer (PCa), little is known of the prevalence of community SV and its relationship with patients' comorbidity burden and health habits such as smoking and alcohol use. We aim to examine whether community social vulnerability is associated with greater burdens of comorbidities and detrimental health habits in men receiving PCa treatment in community urology settings.

Methods: Data for participants in the CaPSURE registry were geocoded, deidentified, and combined with publicly available Social Vulnerability Index (SVI) data. Patients were deemed 'high' SVI if their community was ranked ≥90th percentile nationally for overall SVI rankings and the four SVI domains: socioeconomic status (SES), racial and ethnic minority status (REMS), housing type and transportation (HTT), and household characteristics (HC). Descriptive statistics examined relationships between patient SVI and BMI at diagnosis, number of comorbidities, job type, job status at study enrollment, site of diagnosis, current smoking status, and alcohol consumption.

Results: The cohort included 9,027 individuals (86.3% non-Hispanic White, 10% non-Hispanic Black, and 3.7% Asian/Latino/Other). Mean age at PCa diagnosis was 65.3 years (SD 8.8). 47.6% lived in high SVI neighborhoods; of which 683 (15.9%) were non-Hispanic Black, 3,412 (79.5%) non-Hispanic White, and 198 (4.6%) Asian/Latino/Other. By SVI domain, 15.9% had high community SVI by SES; 5.8% by REMS; 23.2% by HTT; and 30.8% by HC. Significantly more patients from high SVI communities reported an unpaid job compared to those from low SVI communities (70.1% vs 63%, p<0.001). Patients from high SVI communities more commonly smoke (7.1% vs 6.1%, p<0.001) and are less overweight (33.4% vs 36.8%, p<0.001). Higher weekly alcohol consumption was more common in low SV patients (7+, 15.06% vs 13.8%, p<0.001) while high SV patients had greater comorbidity burden (>5 comorbidities, 4.5% vs 3.4%, p<0.001).

Conclusion: Our study found that 47% of men with PCa lived in areas of high SV, with HTT (23%) and HC (31%) being the most common drivers of vulnerability. Greater comorbidity burden, joblessness, current smoking, and lower alcohol use were more common within areas of high SV. These findings highlight the significant interactions between SVI, health related behaviors, and comorbidities for PCa patients within community urology settings. This relationship elucidates a confounding relationship between comorbidities, health habits, and SV independent of access to urologic care. This geocoded SVI data allows for identification of and tailored interventions for neighborhoods with greater social vulnerability, and in turn men with PCa at potentially greater risk of worse outcomes.