Socioeconomic Disparities in Prostate Cancer Presentation: The Impact of ADI on Prostate Cancer Stage at Diagnosis

Objectives: To investigate the impact of socioeconomic deprivation, as measured by Area Deprivation Index (ADI), on PCa stage at diagnosis in a North-American statewide cohort. Methods: The Michigan Department of Health and Human Services (MDHHS) was queried to identify men aged ≥30 with a confirmed diagnosis of PCa at prostate biopsy between 2004 and 2022. An ADI score was assigned to each patient based on their residential census block group. Individuals were further categorized into quartiles, where the fourth 1 (ADI 75-100) represented those living in the most deprived areas. Logistic regression analysis tested the impact of ADI on diagnosis with NCCN high-risk PCa (T3-T4 or PSA >20 ng/ml or ISUP GG ≥4) or metastatic PCa (N1 or M1) at presentation. Results: We included 78018 patients, 17% of whom were Non-Hispanic Black (NHB). Median (IQR) age was 66 (59-72) years. Patients in the most disadvantage quartile (Q4) were more likely to be NHB (40.1% vs. 5.4%), had higher proportion with PSA>20 ng/ml (10.6 % vs. 5.1%), GG≥4 (55.4% vs. 53.1%), clinical T ≥ 3 (4% vs. 3%) and metastasis (3.3% vs. 1.8%) at diagnostic presentation, compared to those in the least disadvantaged quartile (Q1) (all P < .0001). At MVA, for each 10-unit increase in ADI percentile, the relative odds of being diagnosed with NCCN high-risk and metastatic PCa increases by 2% (95% CI, 1.01-1.02) and 4% (95% CI, 1.02-1.05), respectively. Moreover, when compared to NHW men, NHB men had a 1.16 (95% CI, 1.12-1.22) and a 1.52-fold (95% CI, 1.38-1.68) higher relative odds of being diagnosed with NCCN high-risk PCa and metastatic PCa, respectively (P < .001). Conclusions: Living in more deprived areas was associated with higher relative odds of newly diagnosed PCa with unfavorable features. Our study underscores the silent barrier that socioeconomic deprivation poses to cancer early diagnosis and echo the call for tailored interventions to bridge this gap.