Abstract Body (Do not enter title and authors here): Background: Men with prostate cancer (PC) frequently die of cardiovascular disease (CVD). Rurality has shown to increase adverse outcomes in PC men. 26% of Georgians live outside Urban centers and 120/159 counties of Georgia (GA) are considered rural.
Aim: To identify CVD mortality (CVDm) risk factors in GA public health districts (PHD) and map the racial differences in CVDm across PHDs.
Methods: Men ≥ 18 years with PC (2004–2018) were identified using GA Cancer Registry, with mortality data from state vital statistics and National Death Index. CVDm was identified by ICD-10 codes. A multivariable Fine and Gray model identified CVDm risk factors. Adjusted competing risk analysis included factors like PHD, race, age, T-stage, hormone therapy, and Gleason Score. Race specific 5-year CVDm rates per 100000 were calculated by multiplying county-specific standardized mortality ratios (SMRs) by the crude race-specific mortality rates of CVD and then aggregating these into PHDs. The ratio of Black vs White CVDm was calculated for each of GA's 18 PHD and mapped using R.
Results: Of 51,262 men with PC (median age 63), 36.2% were Black, predominantly from greater Atlanta area (36%) and ~17% received hormone therapy. CVDm was noted in 4.1% of cohort. The PC cohort risk factors for CVDm are presented in Table 1.
Men with stage T2-3 PC had a lower risk of CVDm vs stage T1 PC (aHR 0.52, CI 0.36-0.75; aHR 0.47, CI 0.31 – 0.71). CVDm was significantly higher in northwest (aHR 1.72), west central (aHR 1.85), coastal (aHR 1.92), and southeast (aHR 1.90) GA vs. greater Atlanta area. CVDm was significantly higher in Black men (aHR 1.47). High Gleason scores significantly correlated with CVDm (aHR 1.48), though hormone therapy use showed no statistical difference (P=0.124)
Figure 1 shows the mapped relative racial disparity. Overall, the highest Black vs. White CVDm differences were noted in Northeast, LaGrange, and Southwest GA as well as Dekalb County in Atlanta (1.81 - 3.63).
Conclusion: In GA, there are significant geographic and racial differences in CVDm in men with PC. Determining the reasons (i.e., insufficient access to care, inadequate CVD risk prevention) is needed to establish healthcare equity for all men with PC in GA.