Prostate Cancer: Why Money Matters

Poverty May Largely Explain Racial Gap in Survival, Study Shows

Reviewed by Louise Chang, MD on February 13, 2006
From the WebMD Archives

Feb. 13, 2006 -- Men with prostate cancer are more likely to die of the disease if they live in poverty, new research shows.

That may largely explain why elderly blacks are less likely to survive prostate cancer than white or Hispanic men, note the University of Texas' Xianglin Du, MD, PhD, and colleagues.

They checked the medical records of more than 61,000 prostate cancer patients. Their finding: Poverty largely accounted for racial gaps in prostate cancer survival.

"Lower socioeconomic status appeared to be one of the major barriers to achieving comparable outcomes for men with prostate [cancer]," Du's team writes in Cancer.

Tracking Prostate Cancer

The researchers used a large national cancer database. They studied men age 65 and older who only had health coverage through Medicare.

The patients, diagnosed with prostate cancer in the 1990s, were followed for up to 11 years. They included more than 53,000 whites, more than 6,300 blacks, and more than 1,100 Hispanics.

The patients' age, education, poverty, income, cancer treatment, and race were noted. Income was estimated based on the participants' home ZIP code.

The researchers used the men's Gleason scores to gauge disease grade status. Gleason scores range from two to 10. Lower numbers indicate tumors that are expected to grow more slowly and not spread as rapidly.

Race, Money, Survival

As in other studies, blacks were more likely to die of prostate cancer, followed by whites and then Hispanics. Although deaths from prostate cancer have been declining for more than a decade, black men are still more than twice as likely to die from the disease as white men, the American Cancer Society recently reported.

Blacks and Hispanics were much more likely than whites to be living in poverty. Adjusting for that fact drastically shrank the racial survival gap.

For instance, the researchers split socioeconomic status into four brackets. Patients in the lowest bracket were 31% more likely to die of prostate cancer than those in the highest bracket, the study shows.

The study links poverty and poor survival of prostate cancer. But it doesn't rule out other explanations. The racial/ethnic survival gap likely involves several factors, the researchers note.

Beating the Odds

If poverty dims the odds of surviving prostate cancer, society might be able to do something about that, Du and colleagues note.


"These socioeconomic differences are modifiable factors that have important implications in our society," they write. They add that they don't know if the results apply to younger men and men with health insurance beyond Medicare.

"If we make efforts to achieve equal opportunity for education, employment, and health insurance, the Healthy People 2010's goal of eliminating racial disparities in cancer survival is possible," Du's team writes.

Healthy People 2010 is a list of health goals set for America by the U.S. government, with the year 2010 as the deadline.

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SOURCES: Du, X. Cancer, March 15, 2006; vol 106. WebMD Medical Reference from Healthwise: "A-Z Health Guide from WebMD: Grade of Prostate Cancer." WebMD Medical News: "Historic Drop in Cancer Deaths." News release, John Wiley & Sons, Inc.

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