Race/Literacy Effects on Prostate Ca Biology & Access

Race and literacy effects on prostate cancer biology and access.

E. A. Lyons, S. J. Knight, M. S. Wolf, A. Arseven, R. M. Golub, K. Kramer, K. M. Colella, P. Ray, J. Cleofe, C. L. Bennett;

Northwestern University, Chicago, IL; University of California San Francisco, San Francisco, CA; Hines VA, Chicago, IL; Chicago VA Health Care System, Lakeside Division, Chicago, IL; Cook County Hospital, Chicago, IL

Abstract: Background: African Americans present with a higher stage of disease for prostate cancer. Multivariate analysis indicates that low literacy rather than race, is the most likely predictor of advanced stage (Bennett, JCO 1998). We evaluate the relation of race and literacy with Gleason score, PSA level and treatment.

Methods: Newly diagnosed prostate cancer patients were recruited from three Chicago Hospitals (N=143), including two equal access healthcare systems. Patients completed a demographic questionnaire and a literacy evaluation, using a 66 word standard list, the Rapid Estimate of Adult Literacy in Medicine (REALM).

Stage of presentation and treatment decision were abstracted from medical records.

Results: Patients were primarily African American (76%), of lower socioeconomic status (72%) with an income < $20,000, with low literacy skills (65% with <9th grade) and were older than 65 years of age (60%). Bivariate analysis indicated that race and low literacy were significantly associated with Gleason score and PSA respectively.

In a multivariate analysis using literacy, race and age, low literacy was the only significant predictor of PSA > 10ng/mL (OR= 2.8, 95% CI: 1.1-7.7). Of literay, race and age, race was the only predictor for a high Gleason score (OR= 3.0, 95% CI: 1.2-7.1).

Neither race nor literacy were significant predictors of treatment for younger or older patients.

Conclusions: Low literacy, rather than African American race, is the most significant predictor of elevated PSA at presentation, while race is the most significant predictor of a high gleason score.

In order to increase informed decision making about PSA screening, new strategies for health communication need to address the needs of men with lower literacy levels.

Abstract No: 6019


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