A Multilevel Analysis of Socioeconomic Status and Prostate Cancer Risk

Purpose: We investigated whether prostate cancer was associated with socioeconomic status (SES) at the individual level, area level, or a combination of both levels. Methods: This population-based case-control study of prostate cancer in men aged 65 to 79 years was conducted between 2000 and 2002 in South Carolina. Complete interviews were available for 407 incident prostate cancer cases and 393 controls (with respective response rates of 61% and 64%). We used educational level to measure individual-level SES and a composite variable capturing income and education from 2000 Census data to measure area-level SES. Results: After adjustment for race, age, geographic region, and prostate-specific antigen testing, men with some college were at reduced risk for prostate cancer (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.27-0.72), as were men in the highest quartile of area-level SES (OR, 0.52; 95% CI, 0.34-0.80). When assessing individual-level and area-level SES simultaneously and accounting for their nonindependence, the independent negative associations persisted and appeared to be more striking for men with a diagnosis of localized disease, rather than advanced disease. Conclusion: The independent effects of area-level and individual-level SES on prostate cancer risk seen in our study may help explain the conflicting results of previous studies conducted at both levels.