A coordination environment effect of single-atom catalysts on their nitrogen reduction reaction performance.

Understanding the structure-activity relationship of an active site is of great significance toward the rational design of highly active catalysts. In this study, we have performed density functional theory calculations to investigate the coordination environment effect of Fe-, N-, and O-doped carbon on their nitrogen reduction reaction (NRR) properties. Our results indicate that the presence of O atoms in the coordination environment favors the activation of N2 molecules but is unfavorable to the stability, while the existence of N will weaken the adsorption of N2 and increase the reaction barrier of the first hydrogenation step. Fe-C4-C has the lowest potential for activating N2. A compromise is Fe-NxC4-x-C, where the interaction of C and N in coordination regulates the spin polarization of Fe and thus the 3d states around the Fermi level. Fe-N2C2-C was found to be the best one and NRR can proceed via the distal and alternative reaction pathways with the first hydrogenation step of N2 being the potential-limiting step and the Gibbs free energy change (ΔG) being 0.75 eV.

GEOGRAPHICALLY-WEIGHTED REGRESSION ANALYSIS OF PERCENTAGE OF LATE-STAGE PROSTATE CANCER DIAGNOSIS IN FLORIDA.

This study assessed spatial context and the local impacts of putative factors on the proportion of prostate cancer diagnosed at late-stages in Florida during the period 2001-2007. A logistic regression was performed aspatially and by geographically-weighted regression (GWR) at the nodes of a 5 km spacing grid overlaid over Florida and using all the cancer cases within a radius of 125 km of each node. Variables associated significantly with high percentages of late-stage prostate cancer included having comorbidities, smoking, being Black and living in census tracts with farmhouses. Having private or public insurance, being married or diagnosed in a for-profit facility, as well as living in census tracts with high household income reduced significantly this likelihood. Geographically-weighted regression allowed the identification of areas where the local odds ratio is significantly different from the ratio estimated using aspatial regression (State-level). For example, the local odds ratios for the comorbidity covariates were significantly smaller than the State-level odds ratio in Tallahassee and Pensacola, while they were significantly larger in Palm Beach. This emphasizes the need for local strategies and cancer control interventions to reduce the percentage of prostate cancer diagnosed at late-stages and ultimately eliminate health disparities.

Human papillomavirus prevalence in oropharyngeal cancer before vaccine introduction, United States.

We conducted a study to determine prevalence of HPV types in oropharyngeal cancers in the United States and establish a prevaccine baseline for monitoring the impact of vaccination. HPV DNA was extracted from tumor tissue samples from patients in whom cancer was diagnosed during 1995-2005. The samples were obtained from cancer registries and Residual Tissue Repository Program sites in the United States. HPV was detected and typed by using PCR reverse line blot assays. Among 557 invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% for vaccine types HPV16 or 18. Prevalence of HPV-16/18 was lower in women (53%) than in men (66%), and lower in non-Hispanic Black patients (31%) than in other racial/ethnic groups (68%-80%). Results indicate that vaccines could prevent most oropharyngeal cancers in the United States, but their effect may vary by demographic variables.

Prevalence of human papillomavirus types in invasive cervical cancers from 7 US cancer registries before vaccine introduction.

OBJECTIVE: We conducted a baseline study of human papillomavirus (HPV) type prevalence in invasive cervical cancers (ICCs) using data from 7 cancer registries (CRs) in the United States. Cases were diagnosed between 1994 and 2005 before the implementation of the HPV vaccines. MATERIALS AND METHODS: Cancer registries from Florida, Kentucky, Louisiana, Michigan, Hawaii, Iowa, and Los Angeles, California identified eligible ICC cases and obtained sections from representative blocks of archived tumor specimens for DNA extraction. All extracts were assayed by linear array and, if inadequate or HPV negative, retested with INNO-LiPA Genotype test. Clinical and demographic factors were obtained from the CRs and merged with the HPV typing data to analyze factors associated with different types and with HPV negativity. RESULTS: A total of 777 ICCs were included in this analysis, with broad geographic, age, and race distribution. Overall, HPV was detected in 91% of cases, including 51% HPV-16, 16% HPV-18 (HPV-16-negative), and 24% other oncogenic and rare types. After HPV-16 and -18, the most common types were 45, 33, 31, 35, and 52. Older age and nonsquamous histology were associated with HPV-negative typing. CONCLUSIONS: This study provides baseline prevaccine HPV types for postvaccine ICC surveillance in the future. HPV-16 and/or -18 were found in 67% of ICCs, indicating the potential for vaccines to prevent a significant number of cervical cancers.

Cancer Registry Enrichment via Linkage with Hospital-Based Electronic Medical Records: A Pilot Investigation.

Background: Hospital electronic medical record (EMR) systems are becoming increasingly integrated for management of patient data, especially given recent policy changes issued by the Centers for Medicaid and Medicare Services. In addition to data management, these data provide evidence for patient-centered outcomes research for a range of diseases, including cancer. Integrating EMR patient data with existing disease registries strengthens all essential components for assuring optimal health outcomes. Objectives: To identify the mechanisms for extracting, linking, and processing hospital EMR data with the Florida Cancer Data System (FCDS); and to assess the completeness of existing registry treatment data as well as the potential for data enhancement. Methods: A partnership among the Florida Department of Health, FCDS, and a large Florida hospital system was established to develop methods for hospital EMR extraction and transmission. Records for admission years between 2007 and 2010 were extracted using ICD-9-CM codes as the trigger and were linked with the cancer registry for patients with invasive cancers of the breast. Results: A total of 11,506 unique patients were linked with a total of 12,804 unique breast tumors. Evaluation of existing registry treatment data against the hospital EMR produced a total of 5% of registry records with updated surgery information, 1% of records with updated radiation information, and 7% of records updated with chemotherapy information. Enhancement of registry treatment information was particularly affected by the availability of chemotherapy medications data. Conclusion: Hospital EMR linkages to cancer disease registries is feasible but challenged by lack of standards for data collection, coding and transmission, comprehensive description of available data, and the exclusion of certain hospital datasets. The FCDS standard treatment data variables are highly robust and complete but can be enhanced by the addition of detailed chemotherapy regimens that are commonly used in patient centered outcomes research.

Human papillomavirus prevalence in invasive anal cancers in the United States before vaccine introduction.

OBJECTIVE: This study aimed to conduct a representative survey of human papillomavirus (HPV) prevalence and its genotype distribution in invasive anal cancer specimens in the United States. MATERIALS AND METHODS: Population-based archival anal cancer specimens were identified from Florida, Kentucky, Louisiana, and Michigan cancer registries and Surveillance, Epidemiology, and End Results (SEER) tissue repositories in Hawaii, Iowa, and Los Angeles. Sections from 1 representative block per case were used for DNA extraction. All extracts were assayed first by linear array and retested with INNO-LiPA if inadequate or HPV negative. RESULTS: Among 146 unique invasive anal cancer cases, 93 (63.7%) were from women, and 53 (36.3%) were from men. Human papillomavirus (any type) was detected in 133 cases (91.1%) and 129 (88.4%) contained at least 1 high risk-type, most (80.1%) as a single genotype. Human papillomavirus type 16 had the highest prevalence (113 cases, 77.4%); HPV types 6, 11, 18, and 33 were also found multiple times. Among HPV-16-positive cases, 37% were identified as prototype variant Ep, and 63% were nonprototypes: 33% Em, 12% E-G131G, 5% Af1, 4% AA/NA-1, 3% E-C109G, 3% E-G131T, 2% As, and 1% Af2. No significant differences in the distributions of HPV (any), high-risk types, or HPV-16/18 were seen between sex, race, or age group. CONCLUSIONS: The establishment of prevaccine HPV prevalence in the United States is critical to the surveillance of vaccine efficacy. Almost 80% of anal cancers were positive for the vaccine types HPV-16 or HPV-18, and in 70%, these were the only types detected, suggesting that a high proportion might be preventable by current vaccines.

Prevalence of human papillomavirus types in invasive vulvar cancers and vulvar intraepithelial neoplasia 3 in the United States before vaccine introduction.

OBJECTIVE: The study aimed to determine the baseline prevalence of human papillomavirus (HPV) types in invasive vulvar cancer (IVC) and vulvar intraepithelial neoplasia 3 (VIN 3) cases using data from 7 US cancer registries. MATERIALS AND METHODS: Registries identified eligible cases diagnosed in 1994 to 2005 and requested pathology laboratories to prepare 1 representative block for HPV testing on those selected. Hematoxylin-eosin-stained sections preceding and following those used for extraction were reviewed to confirm representation. Human papillomavirus was detected using L1 consensus polymerase chain reaction (PCR) with PGMY9/11 primers and type-specific hybridization, with retesting of samples with negative and inadequate results with SPF10 primers. For IVC, the confirmatory hematoxylin-eosin slides were re-evaluated to determine histological type. Descriptive analyses were performed to examine distributions of HPV by histology and other factors. RESULTS: Human papillomavirus was detected in 121/176 (68.8%) cases of IVC and 66/68 (97.1%) cases of VIN 3 (p < .0001). Patients with IVC and VIN 3 differed by median age (70 vs 55 y, p = .003). Human papillomavirus 16 was present in 48.6% of IVC cases and 80.9% of VIN 3 cases; other high-risk HPV was present in 19.2% of IVC cases and 13.2% of VIN 3 cases. Prevalence of HPV differed by squamous cell carcinoma histological subtype (p < .0001) as follows: keratinizing, 49.1% (n = 55); nonkeratinizing, 85.7% (n = 14), basaloid, 92.3% (n = 14), warty 78.2% (n = 55), and mixed warty/basaloid, 100% (n = 7). CONCLUSIONS: Nearly all cases of VIN 3 and two thirds of IVC cases were positive for high-risk HPV. Prevalence of HPV ranged from 49.1% to 100% across squamous cell carcinoma histological subtypes. Given the high prevalence of HPV in IVC and VIN 3 cases, prophylactic vaccines have the potential to decrease the incidence of vulvar neoplasia.

Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006.

BACKGROUND: Most melanoma studies use data from the National Cancer Institute Surveillance, Epidemiology, and End Results Program or individual cancer registries. Small numbers of melanoma cases have limited in-depth analyses for all racial and ethnic groups. OBJECTIVE: We sought to describe racial and ethnic variations in melanoma incidence and survival. METHODS: Incidence for invasive melanoma and 5-year melanoma-specific survival were calculated for whites, blacks, American Indians/Alaskan Natives, Asians/Pacific Islanders (API), and Hispanics using data from 38 population-based cancer registries. RESULTS: Incidence rates of melanoma were significantly higher for females than males among whites and Hispanics under 50 years of age and APIs under 40 years of age. White and black patients were older (median age: 59-63 years) compared with Hispanics, American Indians/Alaskan Natives, and API (median age: 52-56 years). The most common histologic type was acral lentiginous melanoma among blacks and superficial spreading melanoma among all other racial and ethnic groups. Hispanics had the highest incidence rate of acral lentiginous melanoma, significantly higher than whites and API. Nonwhites were more likely to have advanced and thicker melanomas at diagnosis and lower melanoma-specific survival compared with whites. LIMITATIONS: Over 50% of melanoma cases did not have specified histology. The numbers of nonwhite patients were still relatively small despite broad population coverage (67% of United States). CONCLUSIONS: Racial and ethnic differences in age at melanoma diagnosis, anatomic sites, and histologic types suggest variations in etiologic pathways. The high percentages of advanced and thicker melanomas among nonwhites highlight the need to improve melanoma awareness for all race and ethnicity in the United States.

Association between cutaneous melanoma incidence rates among white US residents and county-level estimates of solar ultraviolet exposure.

BACKGROUND: Recent US studies have raised questions as to whether geographic differences in cutaneous melanoma incidence rates are associated with differences in solar ultraviolet (UV) exposure. OBJECTIVES: We sought to assess the association of solar UV exposure with melanoma incidence rates among US non-Hispanic whites. METHODS: We assessed the association between county-level estimates of average annual solar UV exposure for 1961 to 1990 and county-level melanoma incidence rates during 2004 to 2006. We used Poisson multilevel mixed models to calculate incidence density ratios by cancer stage at diagnosis while controlling for individuals' age and sex and for county-level estimates of solar UV exposure, socioeconomic status, and physician density. RESULTS: Age-adjusted rates of early- and late-stage melanoma were both significantly higher in high solar UV counties than in low solar UV counties. Rates of late-stage melanoma incidence were generally higher among men, but younger women had a higher rate of early-stage melanoma than their male counterparts. Adjusted rates of early-stage melanoma were significantly higher in high solar UV exposure counties among men aged 35 years or older and women aged 65 years or older. LIMITATIONS: The relationship between individual-level UV exposure and risk for melanoma was not evaluated. CONCLUSIONS: County-level solar UV exposure was associated with the incidence of early-stage melanoma among older US adults but not among younger US adults. Additional studies are needed to determine whether exposure to artificial sources of UV exposure or other factors might be mitigating the relationship between solar UV exposure and risk for melanoma.

Disparities in hypertension control advice according to smoking status.

OBJECTIVES: Hypertension is the most common modifiable cardiovascular risk factor. Blood pressure (BP) reduction, particularly among smokers, is highly effective at preventing cardiovascular diseases. We examined the association between patient smoking status and hypertension management advice. METHODS: Adults who participated in the 2007 Behavioral Risk Factor Surveillance System with self-reported hypertension were examined (n=51,063). Multivariable logistic regression analysis controlling for age, gender, race/ethnicity, education, marital status, insurance status, body mass index, alcohol use, self-reported general health and survey design were conducted to examine the association between smoking status (never, former, or current) and receipt of hypertension control advice. RESULTS: After controlling for potential confounders, being a current smoker was significantly associated with lower odds of receiving advice to lower salt intake (Adjusted Odds Ratio, AOR, 0.91 [95% confidence interval=0.84-0.99]), exercise (AOR 0.89 [0.80-0.98]), and to take hypertensive medication (AOR 0.80 [0.66-0.98]) compared to never smokers. However, hypertensive smokers had greater odds of receiving advice to reduce alcohol consumption (AOR 1.23 [1.10-1.45]). CONCLUSIONS: Although healthcare providers are in an optimal position to provide patient education to improve BP control, hypertensive smokers may be less likely to receive important BP control lifestyle modification messages from their healthcare provider than non-smokers.

Changes in youth cigarette use following the dismantling of an antitobacco media campaign in Florida.

We examined the association of the termination of a successful youth-targeted antitobacco media campaign ("truth") and changes in smoking rates among youths aged 12-17 years in Florida. Six telephone-based surveys were completed during the active media campaign (1998-2001), and 2 postcampaign surveys were completed in 2004 and 2006 (each n approximately 1,800). Prevalence of current smoking among youth observed during the campaign continued to decrease in the first postcampaign survey; however, by the second follow-up survey, youth smoking rates had increased significantly for youth aged 16 years or older. Our findings support the need for consistent antitobacco messaging to reduce the prevalence of youth smoking.

A comprehensive evaluation of outcomes for inflammatory breast cancer.

OBJECTIVE: Inflammatory breast cancer (IBC) remains the breast malignancy with the worst prognosis. We sought to determine the effects of race, socioeconomic status and treatment on outcomes for women with IBC. Study design The Florida cancer registry, inpatient and ambulatory data were queried for patients diagnosed from 1998 to 2002. RESULTS: A total of 935 patients with IBC were identified (1.5% of all breast cancers). Overall, 83.1% were Caucasian, 13.9% African American (AA), and 15.7% Hispanic. The mean age of diagnosis was 57 years old. AA patients presented at a younger age, with higher tumor grade, and were less likely to undergo surgical therapy than their Caucasian counterparts. Median survival time (MST) for the entire cohort was 32 months, while MST for AA patients was 20 months. Patients who received chemotherapy before surgery, surgery without chemotherapy, and surgery before chemotherapy demonstrated an independent, significantly improved outcome in comparison to patients who underwent chemotherapy without surgical extirpation. The administration of radiation therapy did not demonstrate an improvement in survival. By multivariate analysis, AA race (HR = 2.19) and failure to provide surgery (HR = 2.3) were independent predictors of worse prognosis. No effect of poverty or ethnicity on outcome was observed. CONCLUSIONS: IBC carries a poor prognosis for all patients with significantly worse outcomes for AA women. Multimodality therapy provided the best survival rates.

Bladder cancer clusters in Florida: identifying populations at risk.

PURPOSE: Modifiable risk factors for bladder cancer have been identified, ie tobacco and chemical exposure. We identified high risk bladder cancer areas and risk factors associated with bladder cancer clusters in Florida using individual and area based data. MATERIALS AND METHODS: Spatial modeling was applied to 23,266 early and advanced bladder cancer cases diagnosed between 1998 and 2002 in Florida to identify areas of excess bladder cancer risk. Multivariable regression was used to determine whether sociodemographic indicators, smoking history and proximity to known arsenic contaminated drinking water well sites were associated with bladder cancer diagnosis in a specific area (cluster). RESULTS: A total of 25 clusters were found to have a higher than expected bladder cancer rate, including 13 and 12 of early and late stage disease, respectively. Urban white patients were more likely to live in an advanced bladder cancer cluster. Advanced bladder cancer cluster membership was associated with living in close proximity to known arsenic contaminated drinking water wells. CONCLUSIONS: There are multiple areas of early and late stage bladder cancer clusters in Florida. Individuals in an advanced bladder cancer cluster tended to live close to arsenic contaminated wells. Increased evaluation of potentially contaminated well water is warranted in these high risk areas. Targeted bladder cancer public awareness campaigns, smoking cessation support and potentially targeted screening should also be considered in communities at increased risk for bladder cancer. Our analytical approach can also be used by others to systematically identify communities at high risk for bladder and other cancers.

Self-rated depression and physician-diagnosed depression and anxiety in Florida adults: Behavioral Risk Factor Surveillance System, 2006.

INTRODUCTION: Our purpose was to determine the prevalence and correlates of self-reported symptoms of depression and physician-diagnosed depression and anxiety in Florida adults by using the 2006 Florida Behavioral Risk Factor Surveillance System (BRFSS). METHODS: The BRFSS is an ongoing, state-based telephone health survey of noninstitutionalized adults that uses random-digit dialing. In 2006, an Anxiety and Depression Module was administered in Florida. Eight questions were used to examine current depression. Two additional questions assessed health care provider diagnosis of depressive and anxiety disorders. We used SUDAAN version 9.0 to evaluate the data to accommodate the complex sampling design. RESULTS: Approximately 9% of Florida adults experienced current depression; about 13% had had a diagnosis of depression in their lifetime and 11% had a diagnosis of anxiety in their lifetime. Approximately 44% of respondents with current depression had not had a diagnosis of depression. Current depression and lifetime diagnosis of depression and anxiety were independently associated with sociodemographic variables (being a woman, young, previously married or never married, or unemployed or unable to work), adverse health behaviors (current or former smoking, physical inactivity, or obesity), and chronic health conditions (history of a stroke, diabetes, or asthma). Although the prevalence of depression among non-Hispanic blacks and people with low education levels is higher, members of these groups are less likely than members of other sociodemographic groups to have had depression diagnosed by a physician. CONCLUSION: Depression and anxiety are associated with sociodemographic disadvantages and chronic conditions and risk factors. Knowing the prevalence of depression and anxiety, both self-rated and physician-diagnosed, is useful in identifying unmet mental health needs among subpopulations.

Prostate cancer treatment patterns among racial/ethnic groups in Florida.

BACKGROUND: Prostate cancer is the second leading cause of cancer death among men in the United States. Blacks have the highest incidence and mortality rates. Treatment differences have been observed between black and white men. Brachy monotherapy (BMT) has become popular for localized prostate cancer because of its convenience, being the least invasive, and resulting in better quality of life during and after treatment. No studies have specifically examined BMT in treating localized prostate cancer by race/ethnicity. OBJECTIVES: We sought to (1) describe treatment patterns among men with localized prostate cancer, (2) identify factors affecting the use of BMT, and (3) examine if there was any difference in BMT use by race and ethnicity. METHODS: Florida cancer incidence data of 1994-2003 were used to extract information on men diagnosed with localized prostate cancer along with their demographics, primary payer at diagnosis, tumor stage and treatments. Logistic regression was performed to assess the likelihood of receiving BMT. RESULTS: The study found that surgery and radiation were the 2 major single treatments for localized prostate cancer. The percent of patients receiving BMT treatment increased from 1994 through 2003. Men with the following characteristics were more likely to receive BMT than their counterparts: Non-Hispanic white, older, married, Medicare beneficiaries and military personnel, with well-differentiated tumor, and receiving treatment in facilities with high practice volume and/or located in urban counties. CONCLUSION: There were racial/ethnic differences in localized prostate cancer treatment. Possible reasons for the differences require further research.

Florida bladder cancer trends 1981 to 2004: minimal progress in decreasing advanced disease.

PURPOSE: There are no accepted screening recommendations for bladder cancer, although the greatest risk factors for bladder cancer are identifiable and modifiable, ie tobacco exposure. Bladder cancer survival correlates highly with disease stage. We ascertained whether there have been any demographic changes in the stage at presentation and mortality of bladder cancer in Florida during the last 25 years. MATERIALS AND METHODS: Data from Florida Cancer Data Registry were evaluated on all bladder cancer cases between 1981 and 2004. Cases were coded and analyzed as local, in situ or advanced (regional and distant) disease. Cases were stratified by demographic groups. RESULTS: The overall incidence of bladder cancer decreased slightly in the last 25 years from 24.3 to 20.5 cases per 100,000 population. Overall white and Hispanic males had an almost 3 and 2-fold incidence of bladder cancer, respectively, compared to that in black males. White females had an almost 2-fold increased incidence compared to black and Hispanic females. Advanced stage bladder cancer decreased minimally in the 25 years. White and black females had the smallest decrease in the annual percent change of advanced bladder cancer. There was only a minimal decrease in bladder cancer mortality rates in black and white but not Hispanic individuals. CONCLUSIONS: Despite knowledge of the main risk factors for bladder cancer there were only small decreases in the percent of patients presenting with advanced disease in Florida in the last 25 years. Thus, bladder cancer may be an appropriate cancer for increased public awareness campaigns and potentially targeted screening of high risk populations.

Detecting an association between socioeconomic status and late stage breast cancer using spatial analysis and area-based measures.

OBJECTIVES: To assess the relationship between socioeconomic status (SES) and late stage breast cancer using the cluster detection software SaTScan and U.S. census-derived area-based socioeconomic measures. MATERIALS AND METHODS: Florida's 18,683 women diagnosed with late stage breast cancer (regional or distant stage) between 1998 and 2002 as identified by Florida's population-based, statewide, incidence registry were analyzed by SaTScan to identify areas of higher-than-expected incidence. The relationship between SES and late stage breast cancer was assessed at the neighborhood (block group) level by combining the SaTScan results with area-based SES data. RESULTS: SaTScan identified 767 of Florida's 9,112 block groups that had higher-than-expected incidence of late stage breast cancer. After controlling for patient level insurance status, county level mammography prevalence, and urban/rural residence in the logistic regression model, women living in neighborhoods of severe and near poverty were respectively 3.0 and 1.6 times more likely to live in areas of higher-than-expected incidence of late stage breast cancer when compared with women living in nonpoverty. Additionally, areas in the lowest quartile of mammography usage were almost seven times more likely to have higher-than-expected incidence than areas in the higher quartiles. CONCLUSIONS: In addition to confirming the importance of mammography, results from the present study suggest that "where" you live plays an important role in defining the risk of presenting with late stage breast cancer. Additional research is urgently needed to understand this risk and to leverage the strengths and resources present in all communities to lower the late stage breast cancer burden.

Impact of Comorbidities on Prostate Cancer Stage at Diagnosis in Florida.

To examine the association of major types of comorbidity with late-stage prostate cancer, a random sample of 11,083 men diagnosed with prostate cancer during 2002-2007 was taken from the Florida Cancer Data System. Individual-level covariates included demographics, primary insurance payer, and comorbidity following the Elixhauser Index. Socioeconomic variables were extracted from Census 2000 data and merged to the individual level data. Provider-to-case ratio at county level was alsocomputed. Multilevel logistic regression was used to assess associations between these factors and late-stage diagnosis of prostate cancer. Higher odds of late-stage diagnosis was significantly related to presence of comorbidities, being unmarried, current smoker, uninsured, and diagnosed in not-for-profit hospitals. The study reported that the presence of certain comorbidities, specifically 10 out of the 45, was associated with late-stage prostate cancer diagnosis. Eight out of 10 significant comorbid conditions were associated with greater risk of being diagnosed at late-stage prostate cancer. On the other hand, men who had chronic pulmonary disease, and solid tumor without metastasis, were less likely to be diagnosed with late-stage prostate cancer. Late-stage diagnosis was associated with comorbidity, which is often associated with increased health care utilization. The association of comorbidity with late-stage prostate cancer diagnosis suggests that individuals with significant comorbidity should be offered routine screening for prostate cancer rather than focusing only on managing symptomatic health problems.

Factors associated with overall survival prostate cancer in Florida: a multilevel analysis.

OBJECTIVE: To investigate individual and contextual factors contributing to overall prostate cancer (PCa) survival in Florida. METHODS: A random sample of 6,457 PCa cases diagnosed between 10/1/2001 and 12/31/2007 was extracted from Florida Cancer Data System. Comorbidity was computed following Elixhauser Index. Survival probability curve was generated using Kaplan-Meier method. The Wei, Lin, and Weissfel model was used for the multivariate analysis. RESULTS: Older age at diagnosis was associated with shorter time to death. Current smokers had a higher hazard rate than non-current smokers. Higher hazard of overall mortality was associated with being diagnosed with advanced stage compared with localized stage and having poorly-differentiated tumor compared with well-moderately differentiated tumor. No definitive treatment, radiation alone, and hormone alone were significantly associated with elevated hazard rate compared with surgery. Fifteen comorbidities were significantly associated with shorter time-to-death. CONCLUSIONS: Effective control of comorbidity in PCa patients should help improve life expectancy and lead to prolonged survival.

Impact of Age, Race and Socio-economic Status on Temporal Trends in Late-Stage Prostate Cancer Diagnosis in Florida.

Individual-level data from the Florida Cancer Data System (1981-2007) were analysed to explore temporal trends of prostate cancer late-stage diagnosis, and how they vary based on race, income and age. Annual census-tract rates were computed for two races (white and black) and two age categories (40-65, >65) before being aggregated according to census tract median household incomes. Joinpoint regression and a new disparity statistic were applied to model temporal trends and detect potential racial and socio-economic differences. Multi-dimensional scaling was used as an innovative way to visualize similarities among temporal trends in a 2-D space. Analysis of time-series indicated that late-stage diagnosis was generally more prevalent among blacks, for age category 40-64 compared to older patients covered by Medicare, and among classes of lower socio-economic status. Joinpoint regression also showed that the rate of decline in late-stage diagnosis was similar among older patients. For younger patients, the decline occurred at a faster pace for blacks with rates becoming similar to whites in the late 90s, in particular for higher incomes. Both races displayed distinct spatial patterns with higher rates of late-stage diagnosis in the Florida Panhandle for whites whereas high rates clustered in South-eastern Florida for blacks.