Rapidly measuring spatial accessibility of COVID-19 healthcare resources: a case study of Illinois, USA.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD: The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS: The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION: Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.

Helping Men Find Their Way: Improving Prostate Cancer Clinic Attendance via Patient Navigation.

Navigation programs aim to help patients overcome barriers to cancer diagnosis and treatment. Missed clinic appointments have undesirable effects on the patient, health system, and society, and treatment delays have been shown to result in inferior surgical cure rates for men with prostate cancer (CaP). We sought to measure the impact of patient navigation on CaP clinic adherence. Patient navigators contacted patients prior to their first encounter for known or suspected CaP between 7/1/2016 and 6/30/2017. Encounters from 7/1/2014 to 6/30/2015 were used as a historical control. Patient-variables were analyzed including age, health insurance status, home address, zip code, race, ethnicity, and referring primary care clinic. Encounter-level variables included diagnosis (categorized as known or suspected CaP), date of appointment, type of appointment [new vs. return], and provider. The associations between several factors including navigation contact and these variables with missed appointment were analyzed using generalized linear mixed effects multivariate logistic regression. A total of 2854 scheduled clinic encounters from 986 unique patients were analyzed. Patient navigation resulted in a lower missed appointment rate (8.8% vs. 13.9%, OR = 0.64, IQR 0.44-0.93, p = 0.02 on multivariable analysis). Lack of health insurance (OR = 13.18 [5.13-33.83]), suspected but not confirmed CaP diagnosis (OR = 7.44 [4.85-11.42]), and Black (1.97 [1.06-3.65]) or Hispanic (OR = 3.61 [1.42-9.16]) race, were associated with missed appointment. Implementation of patient navigation reduced missed appointment rates for CaP related ambulatory encounters. Identifying risk factors for missed appointment may aid in targeting navigation services to those most likely to benefit from this intervention.

Interaction of NKX3.1 and SELENOP genotype with prostate cancer recurrence.

BACKGROUND: NKX3.1 is a tumor suppressor frequently lost in prostate cancer. Previous studies by others indicated that the risks associated with reduced NKX3.1 levels can be enhanced by anti-oxidant supplementation. Selenium is an essential component of several proteins with anti-oxidant functions and lower levels of selenium have been associated with greater risk of prostate cancer. In contrast, participants of the select prostate cancer prevention trial were at increased risk of prostate cancer when supplemented with selenium when their baseline selenium levels were high. METHODS: In order to investigate whether there was an interaction between a functional polymorphism in NKX3.1 that results in less protein and selenium status with prostate cancer grade or outcome, plasma selenium levels and the genotypes of NKX3.1 and the selenium carrier protein SELENOP were determined from a cohort of men who underwent radical protatectomy. RESULTS: NKX3.1 and SELENOP genotypes were associated with a more aggressive prostate tumor grade at the time of prostatectomy, but there were no significant interactions of NKX3.1 genotype with either selenium status or SELENOP genotype. There was also a significant association between NKX3.1 genotype and prostate cancer recurrence, however this association was modified by SELENOP genotype, but not with plasma selenium levels. CONCLUSIONS: These data indicate that the impact of selenium status on prostate cancer may be influenced by factors other than the amount of selenium in circulation.

Pre-diagnostic carbohydrate intake and treatment failure after radical prostatectomy for early-stage prostate cancer.

PURPOSE: An association between dietary carbohydrate intake and prostate cancer (PCa) prognosis is biologically plausible, but data are scarce. This prospective cohort study examined the relation between pre-diagnostic carbohydrate intake and treatment failure following radical prostatectomy for clinically early-stage PCa. METHODS: We identified 205 men awaiting radical prostatectomy and assessed their usual dietary intake of carbohydrates using the 110-item Block food frequency questionnaire. We also evaluated carbohydrate intake quality using a score based on the consumption of sugars relative to fiber, fat, and protein. Logistic regression analyzed their associations with the odds of treatment failure, defined as a detectable and rising serum prostate-specific antigen (PSA) or receiving androgen deprivation therapy (ADT) within 2 years. RESULTS: Sucrose consumption was associated with a higher odds and fiber consumption with a lower odds of ADT after accounting for age, race/ethnicity, body mass index, and tumor characteristics (odds ratio [OR] (95% confidence interval [CI]) 5.68 (1.71, 18.9) for 3rd vs. 1st sucrose tertile and 0.88 (0.81, 0.96) per gram of fiber/day, respectively). Increasing carbohydrate intake quality also associated with a lower odds of ADT (OR (95% CI) 0.78 (0.66, 0.92) per unit increase in score, range 0-12). CONCLUSIONS: Pre-diagnostic dietary carbohydrate intake composition and quality influence the risk of primary treatment failure for early-stage PCa. Future studies incorporating molecular aspects of carbohydrate metabolism could clarify possible underlying mechanisms.

Correlations of SELENOF and SELENOP genotypes with serum selenium levels and prostate cancer.

BACKGROUND: Selenium status is inversely associated with the incidence of prostate cancer. However, supplementation trials have not indicated a benefit of selenium supplementation in reducing cancer risk. Polymorphisms in the gene encoding selenoprotein 15 (SELENOF) are associated with cancer incidence/mortality and present disproportionately in African Americans. Relationships among the genotype of selenoproteins implicated in increased cancer risk, selenium status, and race with prostate cancer were investigated. METHODS: Tissue microarrays were used to assess SELENOF levels and cellular location in prostatic tissue. Sera and DNA from participants of the Chicago-based Adiposity Study Cohort were used to quantify selenium levels and genotype frequencies of the genes for SELENOF and the selenium-carrier protein selenoprotein P (SELENOP). Logistic regression models for dichotomous patient outcomes and regression models for continuous outcome were employed to identify both clinical, genetic, and biochemical characteristics that are associated with these outcomes. RESULTS: SELENOF is dramatically reduced in prostate cancer and lower in tumors derived from African American men as compared to tumors obtained from Caucasians. Differing frequency of SELENOF polymorphisms and lower selenium levels were observed in African Americans as compared to Caucasians. SELENOF genotypes were associated with higher histological tumor grade. A polymorphism in SELENOP was associated with recurrence and higher serum PSA. CONCLUSIONS: These results indicate an interaction between selenium status and selenoprotein genotypes that may contribute to the disparity in prostate cancer incidence and outcome experienced by African Americans.

A geographic information system-based method for estimating cancer rates in non-census defined geographical areas.

PURPOSE: To address locally relevant cancer-related health issues, health departments frequently need data beyond that contained in standard census area-based statistics. We describe a geographic information system-based method for calculating age-standardized cancer incidence rates in non-census defined geographical areas using publically available data. METHODS: Aggregated records of cancer cases diagnosed from 2009 through 2013 in each of Chicago's 77 census-defined community areas were obtained from the Illinois State Cancer Registry. Areal interpolation through dasymetric mapping of census blocks was used to redistribute populations and case counts from community areas to Chicago's 50 politically defined aldermanic wards, and ward-level age-standardized 5-year cumulative incidence rates were calculated. RESULTS: Potential errors in redistributing populations between geographies were limited to <1.5% of the total population, and agreement between our ward population estimates and those from a frequently cited reference set of estimates was high (Pearson correlation r = 0.99, mean difference = -4 persons). A map overlay of safety-net primary care clinic locations and ward-level incidence rates for advanced-staged cancers revealed potential pathways for prevention. CONCLUSIONS: Areal interpolation through dasymetric mapping can estimate cancer rates in non-census defined geographies. This can address gaps in local cancer-related health data, inform health resource advocacy, and guide community-centered cancer prevention and control.

Brief smoking cessation intervention: a prospective trial in the urology setting.

PURPOSE: Urologists have an important role in the treatment of tobacco related diseases, such as kidney and bladder cancer. Despite this role, urologists receive little training in promoting tobacco cessation. We prospectively evaluated a brief smoking cessation intervention offered by a urologist at an outpatient clinic. MATERIALS AND METHODS: Between 2009 and 2011 adult smokers from a single institution urology clinic were enrolled in a prospective, brief intervention trial or in usual care as controls. All patients were assessed by the validated Fagerström test for nicotine dependence and the readiness to quit questionnaire. Trial patients received a 5-minute brief smoking cessation intervention. The primary outcome was abstinence at 1 year and the secondary outcome was the number of attempts to quit. Multivariate logistic regression was used to identify factors associated with the quit rate and quit attempts. RESULTS: A total of 179 patients were enrolled in the study, including 100 in the brief smoking cessation intervention, 41 in the brief smoking cessation intervention plus nicotine replacement therapy and 38 usual care controls. Of the participants 81.0% were 40 years old or older with a mean ± SD 11.26 ± 7.23 pack-year smoking history. Mean readiness to quit and tobacco dependence scores were similar in the 2 arms (p = 0.25 and 0.92, respectively). The 1-year quit rate in the brief smoking cessation intervention group was 12.1% vs 2.6% in the usual care group (OR 4.44, p = 0.163) Adding nicotine replacement therapy increased the quit rate to 19.5% (vs usual care OR 9.91, p = 0.039). Patients who received the brief smoking cessation intervention were significantly more likely to attempt to quit (OR 2.31, p = 0.038). Increased readiness scores were associated with an increased quit rate and increased quit attempts. CONCLUSIONS: Urologists can successfully implement a brief smoking cessation intervention program. Our study highlights the role of the urologist in providing smoking cessation assistance and the significant impact of brief, simple advice about quitting smoking on the smoker quit rate.

Diet adherence dynamics and physiological responses to a tomato product whole-food intervention in African-American men.

Tomatoes may have beneficial effects on prostate health. Efficacy trials would require long-term adherence to high levels of tomato product (TP) consumption. Therefore, factors that affect adherence in men most at risk and whether increased consumption of TP negatively affects diet and health are important concerns. Cancer-free African­American (AA) men (n 36) with mean serum prostate-specific antigen of 7.4 SD 5.6) ng/ml were randomised to consume one serving of TP/d or a control diet for 3 months. Mean intervention group lycopene intake rose to 464%, with negligible control group increase. Plasma lycopene levels rose by 53 and 40% in the intervention group in months 1 and 3, respectively (P < 0.0001), with no control group change. The intervention group's barriers to adherence score was inversely associated with both dietary (r -0.49, P = 0.02) and plasma lycopene concentration (r -0.37, P = 0.02). Their TP disadvantage score negatively correlated with the 3-month plasma lycopene concentrations (r -0.37, P = 0.008) and their weekly incentives and impediments were remarkably stable, 'concern for prostate health' being the most consistent over time. 'Liking tomatoes' and 'study participation' decreased in citation frequency at weeks 6 and 9, respectively. No major shifts occurred in dietary cholesterol or saturated fat, with no adverse effects on gastrointestinal complaints, serum total cholesterol, body weight or blood pressure. Lower socio-economic status AA men at higher prostate cancer risk can successfully achieve a whole food intervention goal with a corresponding rise in plasma lycopene concentrations, with no adverse effects on self-selected diet quality or health parameters.

Ethnicity and smoking status are associated with awareness of smoking related genitourinary diseases.

PURPOSE: Cigarette smoking is a recognized risk factor for kidney cancer, bladder cancer and erectile dysfunction. However, little is known regarding patient knowledge of these associations. We evaluated awareness of smoking as a risk factor for genitourinary disease and identified variables associated with awareness. MATERIALS AND METHODS: We performed a cross-sectional study in a convenience sample of 535 patients who presented to a urology clinic at a major public hospital between 2009 and 2011. Patient demographics and knowledge were captured in a self-reported questionnaire evaluating awareness of smoking as a risk factor for bladder, kidney and lung cancer, and erectile dysfunction. Factors associated with the awareness of smoking and genitourinary disease were identified by multivariable logistic regression. RESULTS: Urology patients generally had low overall awareness of smoking related genitourinary disease. Only 33.5%, 25.2% and 24.2% of patients identified smoking as a risk factor for kidney cancer, bladder cancer and erectile dysfunction, respectively, compared to 94.0% who identified it as a risk factor for lung cancer. Patients from ethnic minorities and current smokers consistently showed a more pronounced lack of awareness of the link between smoking and these diseases. Generally Hispanic and black patients were 2 to 3 times more likely than white patients to be unaware of the association of smoking with the diseases (p = 0.0019 to 0.059). Smokers were twice as likely as nonsmokers to be unaware of the link of smoking with kidney and bladder cancer (p = 0.025 and 0.0509, respectively). CONCLUSIONS: Our study highlights the need for increased awareness of smoking related genitourinary diseases, especially among minority patients and smokers. This study draws attention to an opportunity for urologists to provide smoking cessation assistance and education for this patient population.

Vitamin C and A1c relationship in the National Health and Nutrition Examination Survey (NHANES) 2003-2006.

OBJECTIVE: The scope of the diabetes epidemic stresses the critical need for primary prevention. The consumption of foods high in vitamin C has been associated with lower risk of diabetes. The aim of this study was to analyze the relation between vitamin C concentration and glycemic control index in a large sample of U.S. adults without a history of diabetes. METHODS: We analyzed data collected from 7697 adult participants in the National Health and Nutrition Examination Survey (NHANES) 2003-2006 who did not report a history of diabetes. Multivariate linear regression analyzed the association of vitamin C and hemoglobin A1c (A1c) levels after accounting for potential confounders. We also conducted stratified analyses based on race/ethnicity, gender, age group, body mass index, and vitamin D status. RESULTS: Vitamin C concentrations were inversely associated with A1c (p = 0.0202). Stronger inverse associations were observed in subjects 18-44 years of age (p = 0.0017), as well as in female (p = 0.0035) and Mexican American (p = 0.0149) subgroups. Evidence of a significant interaction between vitamin C and vitamin D was noted in subjects aged 18-44 years and in females (p = 0.0073 and 0.0095 respectively), with the inverse association tending to be evident at lower levels of vitamin D. CONCLUSIONS: Vitamin C status may influence glycemic control. Investigators should be cognizant of the interaction of vitamins C and D and should take this into consideration in planning future studies.

Predictive Risk Factors for Continued Smoking after the Diagnosis of a Genitourinary Malignancy.

OBJECTIVE: To determine risk factors for continued smoking following a diagnosis of a genitourinary (GU) malignancy. Smoking is a well established risk factor in the development of cancers involving the GU tract. Unfortunately, a large percentage of patients continue to smoke or relapse after cancer diagnosis; by doing so, there is an increased risk of recurrence, poor survival rates, treatment complications, secondary primary cancers, and other chronic smoking related illnesses. MATERIALS AND METHODS: Two hundred and five patients who presented to a Urologic Oncology clinic at a single tertiary treatment center were given smoking cessation counseling and pharmacotherapy, as well as a questionnaire which was used to identify smoking status, demographics, and behavioral/psychosocial characteristics. Patients were followed for a minimum of 1 year with a median length of follow up for 13 months. RESULTS: 91% of patients enrolled in the study continued smoking at survey completion. After accounting for age, ethnicity, education and cigarettes consumed/day, 5 variables were independently associated with an increased risk of continued smoking: smoking 20 or more cigarettes per day, less than 2 prior quit attempts, anxiety and/or depression, fear of cancer recurrence, and home secondhand smoke exposure. CONCLUSION: The role of the urologist is imperative for encouraging smoking cessation. While every patient should receive adequate counseling regarding smoking at the time of a GU malignancy diagnosis, identifying patients with the risk factors noted in this study and augmenting smoking cessation efforts may result in stronger efforts to quit and prevention of long-term complications.

Sources of selection and information biases when using commercial database-derived residential histories for cancer research.

PURPOSE: This study examined potential sources of selection and information biases when using residence history information from a commercial database to construct residential histories for cancer research. METHODS: We searched the LexisNexis database for residence data on 3473 adults diagnosed with cancers of the prostate, colon/rectum, and female breast in a single health-care system between 2005 and 2016 using the name and address at diagnosis and the birth date. Residential histories were generated from the results using open-source statistical programs from the National Cancer Institute. Multivariable regression models analyzed the associations of the search results with demographic characteristics and all-cause mortality. RESULTS: Racial/ethnic minorities were less likely to match to vendor residence data compared with non-Hispanic whites (odd ratios [95% confidence intervals (CIs)] for non-Hispanic blacks, Hispanics, and Asian/Pacific Islander were 1.66 [1.30, 2.12], 2.92 [2.18, 3.90], and 4.53 [2.72, 7.55], respectively). Being non-Hispanic black was negatively associated with years of residential history (vs. non-Hispanic whites, ß coefficient [95% CI] = -2.57 [-3.40, -1.73]). Not matching to residence data was associated with an increased 5-year odds of death from any cause (vs. matched subjects, odd ratios [95% CI] = 5.92 [4.29, 8.50]). CONCLUSIONS: Differential ascertainment of residence history by race/ethnicity and association of ascertainment with prognosis are potential sources of selection and information biases when using residence data from a commercial database.

Spatial access to primary care providers and colorectal cancer-specific survival in Cook County, Illinois.

BACKGROUND: Spatial access to primary care has been associated with late-stage and fatal breast cancer, but less is known about its relation to outcomes of other screening-preventable cancers such as colorectal cancer. This population-based retrospective cohort study examined whether spatial access to primary care providers associates with colorectal cancer-specific survival. METHODS: Approximately 26 600 incident colorectal cancers diagnosed between 2000 and 2008 in adults residing in Cook County, Illinois were identified through the state cancer registry and georeferenced to the census tract of residence at diagnosis. An enhanced two-step floating catchment area method measured tract-level access to primary care physicians (PCPs) in the year of diagnosis using practice locations obtained from the American Medical Association. Vital status and underlying cause of death were determined using the National Death Index. Fine-Gray proportional subdistribution hazard models analyzed the association between tract-level PCP access scores and colorectal cancer-specific survival after accounting for tract-level socioeconomic status, case demographics, tumor characteristics, and other factors. RESULTS: Increased tract-level access to PCPs was associated with a lower risk of death from colorectal cancer (hazard ratio [HR], 95% confidence interval [CI]) = 0.87 [0.79, 0.96], P = .008, highest vs lowest quintile), especially among persons diagnosed with regional-stage tumors (HR, 95% CI = 0.80 [0.69, 0.93], P = .004, highest vs lowest quintile). CONCLUSIONS: Spatial access to primary care providers is a predictor of colorectal cancer-specific survival in Cook County, Illinois. Future research is needed to determine which areas within the cancer care continuum are most affected by spatial accessibility to primary care such as referral for screening, accessibility of screening and diagnostic testing, referral for treatment, and access to appropriate survivorship-related care.

The ratio of oleic-to-stearic acid in the prostate predicts biochemical failure after radical prostatectomy for localized prostate cancer.

PURPOSE: To identify lifestyle related factors that may influence the prognosis of clinically localized prostate cancer we evaluated the relative impact of obesity and prostatic fatty acid concentrations at diagnosis on the risk of biochemical failure following radical prostatectomy. MATERIALS AND METHODS: Height and weight were measured in 195 men scheduled for radical prostatectomy for clinically localized prostate cancer. Fatty acids were measured in nonmalignant prostate tissue collected at surgery. Biochemical failure was defined as detectable serum prostate specific antigen (0.1 ng/ml or greater). Cox proportional hazards models and logistic regression, respectively, were used to analyze the association of obesity (body mass index 30 kg/m2 or greater) and prostatic fatty acid concentrations with time to biochemical failure and the relative odds of biochemical failure at different time points after accounting for prostate specific antigen at diagnosis, surgical margin status, pathological stage, Gleason sum, patient age, race/ethnicity and other factors. RESULTS: During an average followup of 56 months the oleic-to-stearic acid ratio predicted the risk of biochemical failure (multivariate HR 1.50, 95% CI 1.17-1.91, p = 0.001 per 1 standard deviation increase). Obesity did not correlate with biochemical failure during the entire study period. However, obesity tended to be associated with biochemical failure within the first 2 years (multivariate OR 2.55, 95% CI 0.84-7.77, p = 0.10). CONCLUSIONS: The oleic-to-stearic acid ratio in the prostate predicts the risk of biochemical failure following radical prostatectomy for clinically localized prostate cancer. This observation and the tendency of obesity to be associated with biochemical failure during the first 2 years in our cohort suggest that lifestyle related factors influence the prognosis of clinically early stage prostate cancer.

Gleason grading of prostate cancer: level of concordance between pathologists at the University Hospital of the West Indies.

Our aim was to study the level of interobserver concordance in the Gleason scores of prostate needle biopsy specimens reported at 1 institution. A retrospective review of all prostate needle biopsy specimens in which a diagnosis of adenocarcinoma was made during the year 2000 was conducted. Parameters evaluated included the Gleason score, Gleason grades identified, the percentage of Gleason grades 4 and 5, and the percentage of tumor in the biopsy specimen. Our results demonstrated a 60% overall concordance in consensus Gleason scores, which increased to 80% when considered in groups of a Gleason score of less than 7 vs 7 or more. The greatest discordance seemed to be in distinguishing Gleason score 6 from 7 and was more frequent among biopsy specimens with lower tumor volumes, particularly among those with less than 30% involvement. A small percentage of Gleason grade 4 pattern might predict disagreement as well. Strategies for improving accuracy of Gleason score 7 should be devised, and consensus diagnosis for biopsy specimens that demonstrate a low percentage of tumor volume is recommended.

Spatial error in geocoding physician location data from the AMA Physician Masterfile: implications for spatial accessibility analysis.

The accuracy of geocoding hinges on the quality of address information that serves as input to the geocoding process; however errors associated with poor address quality are rarely studied. This paper examines spatial errors that arise due to incorrect address information with respect to physician location data in the United States. Studies of spatial accessibility to physicians in the U.S. typically rely on data from the American Medical Association's Physician Masterfile. These data are problematic because a substantial proportion of physicians only report a mailing address, which is often the physician's home (residential) location, rather than the address for the location where health care is provided. The incorrect geocoding of physicians' practice locations based on inappropriate address information results in a form of geocoding error that has not been widely analyzed. Using data for the Chicago metropolitan region, we analyze the extent and implications of geocoding error for measurement of spatial accessibility to primary care physicians. We geocode the locations of primary care physicians based on mailing addresses and office addresses. The spatial mismatch between the two is computed at the county, zip code and point location scales. Although mailing and office address locations are quite close for many physicians, they are far apart (>20 km) for a substantial minority. Kernel density estimation is used to characterize the spatial distribution of physicians based on office and mailing addresses and to identify areas of high spatial mismatch between the two. Errors are socially and geographically uneven, resulting in overestimation of physician supply in some high-income suburban communities, and underestimation in certain central city locations where health facilities are concentrated. The resulting errors affect local measures of spatial accessibility to primary care, biasing statistical analyses of the associations between spatial access to care and health outcomes.

Association of census tract-level socioeconomic status with disparities in prostate cancer-specific survival.

BACKGROUND: Social determinants of prostate cancer survival and their relation to racial/ethnic disparities thereof are poorly understood. We analyzed whether census tract-level socioeconomic status (SES) at diagnosis is a prognostic factor in men with prostate cancer and helps explain racial/ethnic disparities in survival. METHODS: We used a retrospective cohort of 833 African American and white, non-Hispanic men diagnosed with prostate cancer at four Chicago area medical centers between 1986 and 1990. Tract-level concentrated disadvantage (CD), a multidimensional area-based measure of SES, was calculated for each case, using the 1990 U.S. census data. Its association with prostate cancer-specific survival was measured by using Cox proportional hazard models adjusted for case and tumor characteristics, treatment, and health care system [private sector vs. Veterans Health Administration (VA)]. RESULTS: Tract-level CD associated with an increased risk of death from prostate cancer (highest vs. lowest quartile, HR = 2.37, P < 0.0001). However, the association was observed in the private sector and not in the VA (per 1 SD increase, HR = 1.33, P < 0.0001 and HR = 0.93, P = 0.46, respectively). The multivariate HR for African Americans before and after accounting for tract-level CD was 1.30 (P = 0.0036) and 0.96 (P = 0.82), respectively. CONCLUSIONS: Census tract-level SES is a social determinant of prostate-specific mortality and helps account for racial/ethnic disparities in survival. An equal-access health care system may moderate this association. IMPACT: This study identifies a potential pathway for minimizing disparities in prostate cancer control. The findings need confirmation in a population-based study.

Association of A1C levels with vitamin D status in U.S. adults: data from the National Health and Nutrition Examination Survey.

OBJECTIVE: Data relating vitamin D status with indices of glucose homeostasis as manifested by A1C in the U.S. adult population are few. RESEARCH DESIGN AND METHODS: We examined the association between serum 25 hydroxyvitamin D [25(OH)D] and A1C levels in 9,773 adults (age >or=18 years old) participating in the 2003-2006 National Health and Nutrition Examination Survey. Multivariate linear regression analyzed the association after accounting for potential confounders. RESULTS Serum 25(OH)D levels were inversely associated with A1C levels in subjects age 35-74 years (P = 0.0045) and those who did not report a history of diabetes (P = 0.0282). CONCLUSIONS: These findings support a mechanistic link between serum vitamin D concentrations, glucose homeostasis, and the evolution of diabetes in a large segment of the U.S. adult population. Screening people with elevated A1C levels for vitamin D insufficiency should be considered.

The training of epidemiologists and diversity in epidemiology: findings from the 2006 Congress of Epidemiology survey.

PURPOSE: In the past decade, we have witnessed increasing numbers of individuals entering the field of epidemiology. With the increase also has come a diversity of training and paths by which individuals entered the field. The purpose of this survey was characterization of the epidemiology workforce, its job diversity, and continuing education needs. METHODS: The Minority Affairs and Membership committees of the American College of Epidemiology (ACE) prepared and administered a workforce survey to identify racial/ethnic diversity, demographic background, workplace type, credentials, income, subspecialties, and continuing education needs of epidemiologists. The survey was self-administered to attendees of the Second North American Congress of Epidemiology in June 2006. RESULTS: A sample of 397 respondents of the 1348 registered for the Congress was captured (29.5% response). Epidemiologists who participated were from 36 states and 18 countries; 54.6% were trained at the doctoral level; 19.1% earned $120,001 or more a year. A wide range of epidemiology subspecialties and continuing education needs were identified. CONCLUSIONS: This preliminary snapshot of epidemiologists indicates a wide range of training mechanisms, workplace sites, and subspecialties. Results indicate a need for examination of the core graduate training needs of epidemiologist as well as responding to desired professional development needs through the provision of continuing education efforts.