Socio-behavioral needs and prostate and breast cancer mortality rates in African Americans, Hispanics, and Non-Hispanic Whites: A national descriptive exploration within groups.

Abstract

e13825 Background: While previous studies have identified higher mortality rates in African Americans diagnosed with prostate and breast cancer compared to other groups in the U.S, there remains a critical need to understand how socio-behavioral (SB) needs differ within racial/ethnic groups living in areas with different cancer mortality rates across the country. Methods: We investigated socio-behavioral needs differences within racial/ethnic groups living in counties classified per tertiles of high, medium, and low average cancer mortality rates. We obtained age-adjusted breast and prostate cancer mortality rates data stratified by race and ethnicity between 2018 and 2022 for African Americans, Hispanics, and Non-Hispanics Whites, from the National Cancer Institute. We obtained county-level data for 59 social and behavioral determinants of health (SBDH) and population counts by race and ethnicity sourced from various national surveillance sources. The SBDH variables were classified into 7 categories: community solidarity education, health literacy and digital connectivity quality care; housing and environmental risks; economic livelihoods; lifestyle behaviors; and care engagement. SB-needs scores were calculated for each racial/ethnic group by mortality rate tertile. Results: 3,142 counties were included. Among female adults, 13.5 million (84%) Non-Hispanic African Americans, 16 million (78%) Hispanic, and 71 million (94%) Non-Hispanic Whites of the population were included. The highest SB-needs scores for all women were lifestyle behaviors, economic livelihoods and community solidarity. Among male adults, we included 11 million (78%) Non-Hispanic African Americans , 14.6 million (70%) Hispanics, and 67 million (91%) Non-Hispanic Whites. For men, SB-needs scores were high for housing & environment and low for access to quality of care. For White women and men, higher overall SB-needs scores correlated with higher mortality rate tertiles. Among African Americans and Hispanic women, the overall SB-needs score showed a more significant increase when transitioning from low to medium mortality rate counties than from medium to high mortality rate counties. For Hispanic men, SB-needs scores did not align with higher mortality tertiles. Conclusions: SB-needs scores exhibit varying relationships with breast and prostate cancer mortality rates within racial/ethnic groups. These findings generate hypotheses that (1) a linear relationship may exist between SB-needs and mortality rates for Non-Hispanic Whites, while (2) a non-linear relationship may characterize African Americans and Hispanics. Additionally, there may be a threshold for the association of SB-needs on mortality rates, beyond which other factors, such as structural racism (not measured in this study), may play a substantial role.