Psychosocial factors and overall mortality after prostate cancer diagnosis among predominantly low-income Black and White adults

Abstract

BACKGROUND: Psychosocial factors may influence prostate cancer (PCa) survival, but evidence is limited for low-income populations. METHODS: This study used data from the Southern Community Cohort Study (SCCS), a prospective cohort of ∼85 000 individuals aged 40-79, from predominantly low-income backgrounds, enrolled between 2002 and 2009 across 12 southeastern states. A total of 1367 men (1058 Black and 309 White) developed PCa during the follow-up of 34 313 men were included. The Kaplan-Meier method was used to generate 5-year survival rates with log-rank tests for statistical significance. Multivariable Cox models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for psychosocial-mortality associations. RESULTS: Over 18 years of follow-up, 291 Black (27.5%) and 59 White (19.1%) PCa patients died (P = .03). White men self-reporting major depressive symptoms and their inability to control important things in life (ITC) had an 11% (Psurvival = .01) and 12% (Psurvival = .01) lower 5-year survival compared with those who did not, with aHR of 2.56, (95% CI = 1.13 to 5.77) and 2.30 (95% CI = 1.07 to 4.95), respectively. Inverse associations were found for per SD increase in depression score (aHR = 0.84, 95% CI = 0.74 to 0.96) among Black patients. Testing for multiplicative interaction was significant for race-depression (Pinteraction = .02) and race-ITC (Pinteraction = .04). The associations were mainly seen among PCa cases diagnosed within 5 years after baseline survey. CONCLUSION: Psychosocial-mortality associations among PCa patients are complex and may not affect individuals equally. Programs aiming to reduce mortality for individuals with PCa should consider their psychosocial needs and demographic background.