Background: Long-term urinary adverse events (UAEs) following prostate cancer treatment significantly impact survivor quality of life. Previous research suggests disparities in prostate cancer outcomes across geographic and sociodemographic lines, but a comprehensive analysis of treatment-related UAEs is lacking.
Study design: Using SEER-Medicare data (1999-2019), we conducted a retrospective cohort study of men aged ≥66 with non-metastatic prostate cancer treated within 12 months of diagnosis. Rural versus urban residence was determined using Rural-Urban Continuum Codes. UAE risk was assessed using multivariable Cox models and competing risks regression, adjusting for demographics, education, income, comorbidities, and treatment type.
Results: Among 166,581 patients, rural residents (16% of cohort) showed lower 15-year cumulative UAE incidence compared to urban residents (17% versus 20%; p<0.001), despite having lower median per capita income ($18,595 vs. $26,343; p<0.001) and less education (19% vs. 12% without high school education; p<0.001). Rural residence was associated with lower UAE rates (adjusted HR [aHR] 0.90, 95% confidence interval [CI] 0.86-0.94). Higher risk was observed among Hispanic (aHR 1.18, 95% CI 1.11-1.25) and Non-Hispanic Black patients (aHR 1.11, 95% CI 1.05-1.16), those with lower education (aHR 1.31, 95% CI 1.23-1.39 for lowest vs. highest quartile), and patients aged ≥80 years (aHR 1.54, 95% CI 1.47-1.61).
Conclusion: Rural residence was unexpectedly associated with lower UAE rates following prostate cancer treatment. However, significant disparities persisted across racial and socioeconomic lines, with higher risks among minority and less educated patients, suggesting complex relationships between geography, demographics, and treatment outcomes.
Keywords: SEER-Medicare; healthcare disparities; prostate cancer; rural population; treatment outcome; urinary adverse events.
