The Role of Poverty in Prostate The Role of Poverty in Prostate Cancer in African-AmericansCancer in African-Americans

M. Norman Oliver, M.D., M.A.,M. Norman Oliver, M.D., M.A.,Assistant Professor, University of Virginia Departments

of Family Medicine, Health Evaluation Sciences, and Anthropology;

Eric Smith, M.S.,Eric Smith, M.S.,University of Virginia Department of Family Medicine;

Mir Siadaty, M.S., M.D.,Mir Siadaty, M.S., M.D.,University of Virginia Department of Health Evaluation

Sciences

AcknowledgementsAcknowledgements

• Research supported by grants from the National Cancer Institute (1 K07 CA099983-01) and the University of Virginia Paul Mellon Prostate Cancer Research Institute.

Prostate cancer scourgeProstate cancer scourge

• Second leading cause of cancer death among men

• Unequal burden: African-Americans have both prostate cancer incidence and mortality rates twice that of whites

• Reasons for disparities unclear. Diet? Environmental exposures? Access to health care? Genetic susceptibility?

Data descriptionData description• VCR: Incident prostate cancer cases 1990-99• Geocoded 78% (nearly 31,000 cases)• Cases aggregated to census block group level

for comparison to sociodemographic variables in the 1990 U.S. Census

• Census variables: low education (<12yrs), high education (≥16yrs), income, % rural – all stratified by racial category

0.00000-72.3890072.38901-221.70465

221.70466-375.20333375.20334-579.86368579.86369-990.50718

LOW

HIGH

0.00000-61.7146961.71470-162.93925162.93926-293.66711293.66712-508.78444508.76445-969.08000

LOW

HIGH

HIGH

LOW

0-67-1718-26

27-4748-100

LOW

HIGH

LOW

HIGH

Limitations of studyLimitations of study• VCR a poor-quality cancer registry; problems with

data collection• Only used 78% of VCR data, with large fall out of

rural data• U.S. Census suppresses some data at block group level• Incidence rates calculated using average 1990 and

2000 populations• Spatial and temporal lag: a general challenge for

GIScience in public health

Next stepsNext steps• GIS in cancer control research:

1) statistical modeling of incidence and mortality to identify predictors for intervention2) surveillance – identify clusters for further investigation

• Develop statistical models of VCR data• Diet surveys/ethnographic studies in areas of low

and high incidence• Repeat these steps on data from southeastern U.S.

The Role of Poverty in Prostate The Role of Poverty in Prostate Cancer in African-AmericansCancer in African-Americans

M. Norman Oliver, M.D., M.A.,M. Norman Oliver, M.D., M.A.,Assistant Professor, University of Virginia Departments

of Family Medicine, Health Evaluation Sciences, and Anthropology;

Eric Smith, M.S.,Eric Smith, M.S.,University of Virginia Department of Family Medicine;

Mir Siadaty, M.S., M.D.,Mir Siadaty, M.S., M.D.,University of Virginia Department of Health Evaluation

Sciences