Association of Area Deprivation Index with Prostate Cancer-Specific Mortality in a Contemporary North American Statewide Cohort

Background: Socio-economic status and geographic location contribute to disparities in prostate cancer (PCa) outcomes. This study evaluates the impact of the Area Deprivation Index (ADI) on prostate cancer-specific mortality (PCSM) in a North American statewide cohort. Methods: Using data from the Michigan Department of Health and Human Services (MDHHS), we included men aged 18–74 with histologically confirmed PCa between 2004 and 2022. An ADI score, based on residential census block group and ranked nationally by deprivation percentile, was assigned to each patient. Individuals were grouped into quartiles, with the fourth (ADI 75–100) representing the most deprived. PCSM incidence was estimated after stratification by ADI quartiles using the competing-risk method. A competing-risk regression model, adjusting for covariates, assessed ADI’s impact on PCSM. Results: We included 53,532 patients, 18.4% of whom were NHB (Non H ispanic Black). Median (IQR) age and year at diagnosis were 64 (58–69) years and 2010 (2008–2013), respectively. In the fourth ADI quartile, median diagnosis age was 64 (58–69) vs 63 (58–68) in the first quartile. At 15 years after diagnosis, PCSM cumulative incidence was 3.6%, 5.2%, 5.4%, and 6.9% across increasing ADI quartiles (p < 0.0001). Competing-risk regression showed ADI was significantly associated with higher PCSM hazard. Patients in the fourth quartile had a 1.54-fold (CI: 1.28–1.85; p < .001) higher hazard compared to those in the first. Conclusions: Individuals in the most deprived areas had higher PCSM than those in more advantaged areas, underscoring the impact of socioeconomic factors on cancer outcomes and the need for targeted equity-focused interventions.