Residential segregation, housing status and prostate cancer in African American and white men

Background

African American men have considerably higher incidence of prostate cancer and mortality due to the disease compared to white men in the United States. After much research, however, race, age, family history of the disease and living in a western nation still remain the only consistently reported risk factors for the disease. Social science suggests that race-based residential segregation may be a fundamental cause of racial disparities in health. Segregation affects education, employment, health care, and housing quality. Poor housing conditions have been known to affect health for more than 100 years but have not been studied in regard to prostate cancer risk, although housing differs substantially for African American and white men. Therefore, we hypothesize, that race-based residential segregation leads to disparities in both area (census tract/block group) and individual physical and social housing conditions that dispose African American men to differential environmental conditions that lead to excesses in biological damage, increasing risk for prostate cancer, earlier age of prostate cancer onset, and worse prostate cancer outcomes.

##Study Aims

1. To determine whether selected area housing and individual housing status (homeownership, housing density, and other housing factors such as age of structure and heating sources) are associated with prostate cancer risk, age at diagnosis, and tumor aggressiveness and whether housing status is associated with observed racial differences in these prostate cancer outcomes.

2. To determine, through the use of factor analysis, whether area housing and individual housing status, is associated with prostate cancer risk, age at diagnosis, and tumor aggressiveness, through “latent factors” that include diet, physical activity, and genetic polymorphisms and whether those “latent factors” differ by race.

3. To begin to test biological pathways through which housing status may impact prostate health outcomes; specifically, whether housing status is associated with markers of DNA damage (polycyclic aromatic hydrocarbons DNA-adducts (PAH)) and DNA stability (telomere content) in prostate tumor tissue and tumor-adjacent normal tissue of African American and white cases.

##Methods

The study which is funded by the Department of Defense Prostate Cancer Research Program (PI: Christine Neslund-Dudas) is a secondary data analysis of previously enrolled prostate cancer cases and controls accrued for a gene-environment interaction study originally funded by the National Institute of Environmental Health Sciences (PI: Benjamin Rybicki, PhD, Mentor). The study includes men diagnosed and treated for prostate cancer (1999-2004) at Henry Ford Health System in Detroit, Michigan. The parent study now includes nearly 900 men, 42% of whom are African-American. Comprehensive information on dietary intake, physical activity, occupational exposures and medical history, including PSA and DRE screening, are available for these subjects and will be included in the analysis which will assess the independent contribution of housing status to prostate cancer risk. Area-level housing data were captured from the U.S. Census 2000.

##Significance

Very few risk factors are known for prostate cancer, although the disease accounts for nearly 40% of all cancers diagnosed in African American men. This study is examining housing, a previously unexplored area in prostate cancer research. Although this initial study is being conducted in only one CRN site, the CRN provides a unique environment for area-level studies to be conducted, as individual level data, often missing from area-based studies is available and sites are gaining experience in using Geographic Information Systems (GIS) in combination with U.S. Census data. In the future, findings from this study will be used to conduct a larger prostate cancer study across multiple CRN sites, as residential segregation and housing patterns differ n

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