Hari S Iyer1, Linda Valeri2, Peter James3, Jarvis T Chen4, Jaime E Hart5,6, Francine Laden1,5, Michelle D Holmes1,5, Timothy R Rebbeck1,7. 1. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. 2. Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York. 3. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts. 4. Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. 5. Department of Medicine, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts. 6. Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts. 7. Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.
Abstract
BACKGROUND: Black men with prostate cancer (CaP) experience excess mortality compared with White men. Residential greenness, a health promoting contextual factor, could explain racial disparities in mortality among men with CaP. METHODS: We identified Pennsylvania Cancer Registry cases diagnosed between January 2000 and December 2015. Totally, 128,568 participants were followed until death or 1 January 2018, whichever occurred first. Residential exposure at diagnosis was characterized using the Normalized Difference Vegetation Index (NDVI) with 250 m resolution. We estimated hazard ratios (HRs) using Cox models, adjusting for area-level socioeconomic status, geographic healthcare access, and segregation. To determine whether increasing residential greenness could reduce racial disparities, we compared standardized 10-year mortality Black-White risk differences under a hypothetical intervention fixing NDVI to the 75th percentile of NDVI experienced by White men. RESULTS: We observed 29,978 deaths over 916,590 person-years. Comparing men in the highest to lowest NDVI quintile, all-cause (adjusted HR [aHR]: 0.88, 95% confidence interval [CI]: 0.84, 0.92, P trend < 0.0001), prostate-specific (aHR: 0.88, 95% CI: 0.80, 0.99, P trend= 0.0021), and cardiovascular-specific (aHR: 0.82, 95% CI: 0.74, 0.90, P trend < 0.0001) mortality were lower. Inverse associations between an interquartile range increase in NDVI and cardiovascular-specific mortality were observed in White (aHR: 0.90, 95% CI: 0.86, 0.93) but not Black men (aHR: 0.97, 95% CI: 0.89, 1.06; P het = 0.067). Hypothetical interventions to increase NDVI led to nonsignificant reductions in all-cause (-5.3%) and prostate-specific (-23.2%), but not cardiovascular-specific mortality disparities (+50.5%). DISCUSSION: Residential greenness was associated with lower mortality among men with CaP, but findings suggest that increasing residential greenness would have limited impact on racial disparities in mortality.
BACKGROUND: Black men with prostate cancer (CaP) experience excess mortality compared with White men. Residential greenness, a health promoting contextual factor, could explain racial disparities in mortality among men with CaP. METHODS: We identified Pennsylvania Cancer Registry cases diagnosed between January 2000 and December 2015. Totally, 128,568 participants were followed until death or 1 January 2018, whichever occurred first. Residential exposure at diagnosis was characterized using the Normalized Difference Vegetation Index (NDVI) with 250 m resolution. We estimated hazard ratios (HRs) using Cox models, adjusting for area-level socioeconomic status, geographic healthcare access, and segregation. To determine whether increasing residential greenness could reduce racial disparities, we compared standardized 10-year mortality Black-White risk differences under a hypothetical intervention fixing NDVI to the 75th percentile of NDVI experienced by White men. RESULTS: We observed 29,978 deaths over 916,590 person-years. Comparing men in the highest to lowest NDVI quintile, all-cause (adjusted HR [aHR]: 0.88, 95% confidence interval [CI]: 0.84, 0.92, P trend < 0.0001), prostate-specific (aHR: 0.88, 95% CI: 0.80, 0.99, P trend= 0.0021), and cardiovascular-specific (aHR: 0.82, 95% CI: 0.74, 0.90, P trend < 0.0001) mortality were lower. Inverse associations between an interquartile range increase in NDVI and cardiovascular-specific mortality were observed in White (aHR: 0.90, 95% CI: 0.86, 0.93) but not Black men (aHR: 0.97, 95% CI: 0.89, 1.06; P het = 0.067). Hypothetical interventions to increase NDVI led to nonsignificant reductions in all-cause (-5.3%) and prostate-specific (-23.2%), but not cardiovascular-specific mortality disparities (+50.5%). DISCUSSION: Residential greenness was associated with lower mortality among men with CaP, but findings suggest that increasing residential greenness would have limited impact on racial disparities in mortality.
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