BACKGROUND: Personalized therapeutic approaches for localized prostate cancer have evolved significantly, with tissue-based biomarker tests supplementing traditional risk stratification tools. However, national testing patterns and geographic variability remain limited a decade after coverage implementation. We aimed to assess current nationwide utilization and urban-rural differences in tissue-based biomarker testing. METHODS: Using full Medicare claims data, we retrospectively identified patients with newly diagnosed prostate cancer and tissue-based biomarker testing claims from 2019 to 2023. Patients' county of residence was categorized as metro, urban, or rural. Regional testing rates were further assessed across hospital referral regions. A multivariable logistic regression model was performed to assess the effect of residence on test receipt. RESULTS: Our final cohort included 749 202 patients, of whom 79.5% lived in metro, 11.4% in urban and 8.00% in rural counties. Overall, 86 908 (11.6%) patients underwent tissue-based biomarker tests. Hospital referral region-level testing rates ranged from 2.4% to 42.7%. Rural patients were 18% less likely to undergo testing compared to metro patients (odds ratio [OR] 0.82, 95% CI = 0.73 to 0.91). Independently, the odds of undergoing testing were lower among Black (OR 0.82, 95% CI = 0.77 to 0.88) and Hispanic patients (OR 0.80, 95% CI = 0.73 to 0.88) compared to White patients. CONCLUSION: This study reveals high geographic variability in tissue-based biomarker testing for prostate cancer. Further, Black and Hispanic patients were less likely to receive testing. Our findings highlight regional practice variation in the use of advanced, not routinely recommended tests and underscore the need to minimize disparities in diagnostic access.

• MeSH
• běloch MeSH
• černoši nebo Afroameričané statistika a číselné údaje   MeSH
• disparity zdravotní péče * statistika a číselné údaje   etnologie   MeSH
• lidé MeSH
• Medicare * statistika a číselné údaje   MeSH
• městské obyvatelstvo statistika a číselné údaje   MeSH
• nádorové biomarkery * analýza   MeSH
• nádory prostaty * diagnóza   patologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• venkovské obyvatelstvo statistika a číselné údaje   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Spojené státy americké MeSH
• Názvy látek
• nádorové biomarkery * MeSH

Multiple-cause-of-death data have not yet been applied to the study of racial/ethnic differences in causal chains of events leading to death, nor they have been used to examine racial/ethnic disparities in cause-of-death certification. We use publicly available 2019 US death certificate data to reassemble chains of morbid events leading to death. From them, we construct and analyze directed multiple cause of death networks by race and sex of deaths aged 60+. Three perspectives to measure disparities are employed: (i) relative prevalence of cause-of-death-pairs, (ii) strength of associations between diseases, (iii) similarities in transition matrices. Non-Hispanic Blacks (NHB) had overall lower prevalence of cause of death pairs, Hispanics (HIS) were burdened more by alcohol-related mortality and Asian and Pacific Islanders (API) exceeded in transitions to cerebrovascular diseases. Lower similarity was observed in transitions to external causes of death, dementia and Alzheimer's disease, pulmonary heart diseases, interstitial respiratory diseases, and diseases of the liver. After excluding rare diseases, the similarity further decreased for ill-defined conditions, diabetes mellitus, other cardiovascular diseases, diseases of the pleura, and anemia. To sum up, races/ethnicities not only vary in structure and timing of death but they differ in morbid processes leading to death as well.

• MeSH
• analýza sociálních sítí MeSH
• asijští Američané, domorodí Havajci a obyvatelé tichomořských ostrovů statistika a číselné údaje   MeSH
• běloch statistika a číselné údaje   MeSH
• černoši nebo Afroameričané statistika a číselné údaje   MeSH
• diabetes mellitus MeSH
• etnicita * statistika a číselné údaje   MeSH
• Hispánci a Latinoameričané statistika a číselné údaje   MeSH
• indián nebo domorodec z Aljašky statistika a číselné údaje   MeSH
• kardiovaskulární nemoci MeSH
• lidé středního věku MeSH
• lidé MeSH
• morbidita MeSH
• mortalita * etnologie   MeSH
• nemoc * etnologie   MeSH
• příčina smrti * MeSH
• rasové faktory MeSH
• sexuální faktory MeSH
• zdravotní nespravedlnost * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Spojené státy americké epidemiologie   MeSH

BACKGROUND: To test for differences in cancer-specific mortality (CSM) rates between radical prostatectomy (RP) vs external beam radiotherapy (EBRT) in National Comprehensive Cancer Network (NCCN) high-risk African American patients, as well as Johns Hopkins University (JHU) high-risk and very high-risk patients. MATERIALS AND METHODS: Within the Surveillance, Epidemiology, and End Results database (2010-2016), we identified 4165 NCCN high-risk patients, of whom 1944 (46.7%) and 2221 (53.3%) patients qualified for JHU high-risk or very high-risk definitions. Of all 4165 patients, 1390 (33.5%) were treated with RP versus 2775 (66.6%) with EBRT. Cumulative incidence plots and competing risks regression models addressed CSM before and after 1:1 propensity score matching between RP and EBRT NCCN high-risk patients. Subsequently, analyses were repeated separately in JHU high-risk and very high-risk subgroups. Finally, all analyses were repeated after landmark analyses were applied. RESULTS: In the NCCN high-risk cohort, 5-year CSM rates for RP versus EBRT were 2.4 versus 5.2%, yielding a multivariable hazard ratio of 0.50 (95% confidence interval [CI] 0.30-0.84, p = 0.009) favoring RP. In JHU very high-risk patients 5-year CSM rates for RP versus EBRT were 3.7 versus 8.4%, respectively, yielding a multivariable hazard ratio of 0.51 (95% CI: 0.28-0.95, p = 0.03) favoring RP. Conversely, in JHU high-risk patients, no significant CSM difference was recorded between RP vs EBRT (5-year CSM rates: 1.3 vs 1.3%; multivariable hazard ratio: 0.55, 95% CI: 0.16-1.90, p = 0.3). Observations were confirmed in propensity score-matched and landmark analyses adjusted cohorts. CONCLUSIONS: In JHU very high-risk African American patients, RP may hold a CSM advantage over EBRT, but not in JHU high-risk African American patients.

• Klíčová slova
• external beam radiotherapy, high-risk, prostate cancer, radical prostatectomy, very high-risk,
• MeSH
• černoši nebo Afroameričané statistika a číselné údaje   MeSH
• hodnocení rizik * metody   statistika a číselné údaje   MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• mortalita MeSH
• nádory prostaty * etnologie   patologie   radioterapie   chirurgie   MeSH
• program SEER statistika a číselné údaje   MeSH
• prostatektomie * metody   statistika a číselné údaje   MeSH
• radioterapie * metody   statistika a číselné údaje   MeSH
• staging nádorů MeSH
• stupeň nádoru MeSH
• tendenční skóre MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Spojené státy americké epidemiologie   MeSH

PURPOSE: To assess the effect of race/ethnicity in cancer-specific mortality (CSM) adjusted for other-cause mortality (OCM) in metastatic prostate cancer patients (mPCa) treated with external beam radiotherapy (EBRT) to the prostate. METHODS: We relied on the Surveillance, Epidemiology, and End Results (SEER) database to identify Caucasian, African-American, Hispanic/Latino and Asian mPCa patients treated by EBRT between 2004 and 2016. Cumulative incidence plots displayed CSM after adjustment for OCM according to race/ethnicity. Propensity score matching accounted for patient age, prostate-specific antigen, clinical T and N stages, Gleason Grade Groups and M1 substages. OCM adjusted multivariable analyses tested for differences in CSM in African-Americans, Hispanic/Latinos and Asians relative to Cauacasians. RESULTS: After 3:1 propensity score matching and OCM adjustment, Asians exhibited lower CSM at 60 and 120 months (48.2 and 60.0%, respectively) compared to Caucasians (66.7 and 79.4%, respectively, p < 0.001). In OCM adjusted multivariable analyses, Asian race/ethnicity was associated with lower CSM (HR 0.66, CI 0.52-0.83, p < 0.001). Conversely, African-American and Hispanic/Latino race/ethnicity did not affect CSM. OCM rates were comparable between examined races/ethnicities. CONCLUSION: In the setting of mPCa treated with EBRT, Asians exhibit lower CSM than Caucasians, African-Americans and Hispanic/Latinos. This observation may warrant consideration in prognostic stratification schemes for newly diagnosed mPCa patients.

• Klíčová slova
• Cancer-specific mortality, External beam radiotherapy, Metastatic prostate cancer, Other-cause mortality, Race/ethnicity,
• MeSH
• Američané asijského původu statistika a číselné údaje   MeSH
• běloši statistika a číselné údaje   MeSH
• černoši nebo Afroameričané statistika a číselné údaje   MeSH
• Hispánci a Latinoameričané statistika a číselné údaje   MeSH
• karcinom etnologie   mortalita   radioterapie   sekundární   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• mortalita etnologie   MeSH
• nádory kostí etnologie   mortalita   sekundární   MeSH
• nádory prostaty etnologie   mortalita   patologie   radioterapie   MeSH
• program SEER MeSH
• radioterapie * MeSH
• senioři MeSH
• tendenční skóre MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: This study examines satisfaction across life domains (condition of the home, city of residence, daily life/leisure, family life, current financial situation, total household income, health, and life as a whole) among Black adults. The study also explores the association between satisfaction in each life domain and sociodemographic, personality, and mental/physical health measures. METHODS: A community-dwelling sample of Black adults (n = 93, age range = 55-80) residing in the Tampa, FL area, completed a life satisfaction scale and measures of sociodemographic factors, personality, and mental/physical health between October 2014 and June 2016. RESULTS: Better life satisfaction was observed in the oldest-old (80+) compared with the middle-aged (55-64; p < .05). Less education, less financial strain, lower depressive symptoms, and better self-rated physical health were associated with higher satisfaction although the pattern of results varied by domain. CONCLUSIONS: Our findings suggest that the evaluation of life satisfaction domains may be a useful approach for identifying specific individual needs, which may inform age-friendly community initiatives.

• Klíčová slova
• Black adults, Life domains, Life satisfaction, Well-being,
• MeSH
• černoši nebo Afroameričané psychologie   statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• osobní uspokojení * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• socioekonomické faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Florida MeSH

PURPOSE: We hypothesized that differences in active treatment rates may exist according to race/ethnicity in favorable as well as unfavorable intermediate risk prostate cancer. MATERIALS AND METHODS: We relied on the Surveillance, Epidemiology, and End Results 18 database 2010-2015. We stratified according to 3 racial/ethnic groups (White vs Black vs Hispanic) and prostate cancer baseline characteristics (prostate specific antigen, clinical T stage, Gleason group grading, percentage of biopsy cores). We tabulated active treatment rates (radical prostatectomy, external beam radiotherapy) without and with adjustment for baseline age and prostate cancer characteristics. RESULTS: Baseline prostate specific antigen, clinical T stage, Gleason grade and percentage of positive biopsy cores differed according to racial/ethnic groups in both favorable and unfavorable intermediate risk prostate cancer patients (all p <0.05). Similarly, radical prostatectomy and external beam radiotherapy rates differed according to race/ethnicity in both favorable and unfavorable intermediate risk prostate cancer patients. Radical prostatectomy and external beam radiotherapy rates respectively ranged from 31.7%-41.8% and 26.3%-31.0% in favorable intermediate risk cases and from 33.4%-43.9% and 30.9%-35.5% in unfavorable intermediate risk prostate cancer, across the 3 race/ethnicity groups (both p <0.05). The above heterogeneity in active treatment rates disappeared and marginal differences remained after adjustment for baseline age and prostate cancer characteristics. CONCLUSIONS: Interpretation of active treatment rates in favorable and unfavorable intermediate risk prostate cancer may be severely biased, unless detailed and systematic consideration or adjustment for baseline age and prostate cancer characteristic is enforced.

• Klíčová slova
• African Americans, Hispanic Americans, prostatic neoplasms, race factors,
• MeSH
• běloši statistika a číselné údaje   MeSH
• černoši nebo Afroameričané statistika a číselné údaje   MeSH
• disparity zdravotní péče statistika a číselné údaje   MeSH
• Hispánci a Latinoameričané statistika a číselné údaje   MeSH
• hodnocení rizik MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory prostaty krev   patologie   terapie   MeSH
• prostatický specifický antigen krev   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• staging nádorů MeSH
• stupeň nádoru MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• prostatický specifický antigen MeSH

OBJECTIVE: To test the effect of race/ethnicity on histological subtype, stage at presentation, and cancer specific mortality (CSM) in urethral cancer patients. MATERIAL AND METHODS: Stratified analyses (Surveillance, Epidemiology and End Results [2004-2016]) tested the effect of race/ethnicity on histology and stage. Cumulative incidence-plots and multivariable competing-risks regression models (CRR), addressed CSM, after matching for TNM-stage, histology, age, and gender. RESULTS: Of 1,904 urethral cancer patients, 71% were Caucasian, 16% African American, 7% Hispanic and 5% other. African Americans were younger (66 years) than Caucasians (73 years) and Hispanics (74 years). In African Americans, adenocarcinoma (25%) and squamous cell carcinoma (SCC; 29%) were more frequent than in Caucasians (12% and 23%) or Hispanics (15% and 20%). African Americans with adenocarcinoma exhibited higher stage than other adenocarcinoma patients. In CRR, African Americans (35%) and Hispanics (29%) exhibited highest and second highest 3-year CSM, even after matching. After further multivariable adjustment of matched CRRs, CSM was higher in Hispanics (HR: 1.93, P= 0.03) and in African Americans (Hazard ratio 1.35, P= 0.07), relative to Caucasians. CONCLUSION: Race/ethnicity impacts important differences on urethral cancer patients. African American race/ethnicity predisposes to higher rate of SCC and adenocarcinoma. Moreover, African Americans are younger and present with higher stage at diagnoses. Finally, even after most detailed matching for stage, age, gender, and adjustment for treatment and systemic therapy and socioeconomic status, African Americans and Hispanics exhibit higher CSM than Caucasians.

• Klíčová slova
• African American, Hispanic, Mortality, Race, SEER database, Urethral cancer,
• MeSH
• běloši statistika a číselné údaje   MeSH
• černoši nebo Afroameričané statistika a číselné údaje   MeSH
• Hispánci a Latinoameričané statistika a číselné údaje   MeSH
• lidé středního věku MeSH
• lidé MeSH
• míra přežití MeSH
• nádory močové trubice klasifikace   mortalita   patologie   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: To test the association between African-American race and overall mortality (OM) rates in patients with metastatic renal cell carcinoma (mRCC). METHODS: Within the Surveillance, Epidemiology, and End Results registry (2006-2015), we identified patients with clear cell (ccmRCC) and non-clear cell mRCC (non-ccmRCC). African-Americans, Caucasians, and Hispanics were identified. Stratification was made according to histology and treatments: (1) no treatment, (2) systemic therapy (ST), (3) cytoreductive nephrectomy (CNT), (4) CNT + ST. Kaplan-Meier plots and multivariable Cox regression analyses were used. RESULTS: Of ccmRCC patients, 410 (7%), 4353 (75%), and 1005 (17%) were African-American, Caucasian, and Hispanic, respectively. Of non-ccmRCC patients, 183 (25%), 479 (65%), and 77 (10%) were African-American, Caucasian, and Hispanic, respectively. In ccmRCC, African-Americans were associated with higher OM rates (HR 1.20; 95% CI 1.05-1.37). Conversely, in non-ccmRCC, African-Americans were associated with lower OM rates (HR 0.75; 95% CI 0.59-0.97). CONCLUSION: African-American race is associated with prolonged survival in non-ccmRCC, but it is also associated with lower survival rates in ccmRCC. The exception to these observations consisted of patients treated with combination of CNT + ST for either ccmRCC or non-ccmRCC.

• Klíčová slova
• African-American, Caucasian, Cytoreductive nephrectomy, Hispanic, Metastatic renal cell carcinoma, Systemic therapy,
• MeSH
• běloši statistika a číselné údaje   MeSH
• černoši nebo Afroameričané statistika a číselné údaje   MeSH
• Hispánci a Latinoameričané statistika a číselné údaje   MeSH
• karcinom z renálních buněk etnologie   mortalita   patologie   terapie   MeSH
• ledviny patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• metastázy nádorů MeSH
• míra přežití MeSH
• nádory ledvin etnologie   mortalita   patologie   terapie   MeSH
• proporcionální rizikové modely MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Geografické názvy
• Itálie epidemiologie   MeSH

BACKGROUND: We investigated whether carotid intima-media thickness is associated with measures of cerebral blood flow (CBF), white matter hyperintensities, and brain volume in a biracial cohort of middle-aged individuals. METHODS: We performed a cross-sectional cohort study based on data from a multicenter, population-based study Coronary Artery Risk Development in Young Adults. Using linear and logistic regression, we estimated the association of the composite intima-media thickness measured in three segments of carotid arteries (common carotid artery, carotid artery bulb, and internal carotid artery) with volume (cm3) and CBF (mL/100 g/min) in the total brain and gray matter as well as volume of white matter hyperintensities (cm3). RESULTS: In the analysis, 461 participants (54% women, 34% African Americans) were included. Greater intima-media thickness was associated with lower CBF in gray matter (β=-1.36; p = .04) and total brain (β=-1.26; p = .04), adjusting for age, sex, race, education, and total brain volume. The associations became statistically nonsignificant after further controlling for cardiovascular risk factors. Intima-media thickness was not associated with volumes of total brain, gray matter, and white matter hyperintensities. CONCLUSIONS: This study suggests that lower CBF in middle age is associated with markers of atherosclerosis in the carotid arteries. This association may reflect early long-term exposure to traditional cardiovascular risk factors. Early intervention on atherosclerotic risk factors may modulate the trajectory of CBF as people age and develop brain pathology.

• Klíčová slova
• Brain perfusion, Carotid intima, Epidemiology, media thickness,
• MeSH
• běloši statistika a číselné údaje   MeSH
• bílá hmota diagnostické zobrazování   MeSH
• černoši nebo Afroameričané statistika a číselné údaje   MeSH
• intimomediální šíře tepenné stěny * MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * MeSH
• mozek diagnostické zobrazování   MeSH
• mozkový krevní oběh * MeSH
• průřezové studie MeSH
• velikost orgánu MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Research Support, N.I.H., Extramural MeSH
• Research Support, N.I.H., Intramural MeSH
• Geografické názvy
• Spojené státy americké MeSH

OBJECTIVE: This study investigates the associations of body mass index (BMI) and waist circumference (WC) with markers of systemic inflammation in midlife by race and gender. DESIGN: Data were obtained from the Survey of Midlife in the United States, a cross-sectional, observational study of Americans 35 years old or older (White men: N = 410; White women: N = 490; Black men: N = 58; Black women: N = 117). Inflammation was measured by concentrations of fibrinogen and C-reactive protein (CRP) in fasting plasma and concentrations of E-selectin and interleukin-6 (IL-6) in fasting serum. Anthropometric data were used to obtain BMI and WC. Socio-demographic and health-related factors were assessed with a survey. Multivariate models by race and gender were estimated to test the roles of BMI and WC for each inflammation marker. RESULTS: Compared to White men, Black women have higher BMI and higher levels of all four inflammation markers; White women have lower BMI, lower WC, and lower E-selectin and fibrinogen but higher CRP; and Black men have higher fibrinogen. After adjusting for socio-demographic and health-related covariates as well as perceived discrimination, WC is associated with all four markers of inflammation among White men and women; with three markers (fibrinogen, CRP, and IL-6) of inflammation among Black women; and with CRP (and marginally with fibrinogen and E-selectin) among Black men. BMI is associated with higher CRP and fibrinogen among Black men (marginally so for White men) but not for women of either race. CONCLUSIONS: WC shows more consistent associations with inflammation markers than BMI, although the relationships vary by inflammation marker and population group. Our findings suggest that WC is a risk factor for systemic inflammation among White and Black men and women, and BMI is an additional risk factor for Black men.

• Klíčová slova
• Inflammation, body mass index, gender, race/ethnicity, waist circumference,
• MeSH
• běloši statistika a číselné údaje   MeSH
• biologické markery MeSH
• C-reaktivní protein biosyntéza   MeSH
• černoši nebo Afroameričané statistika a číselné údaje   MeSH
• dospělí MeSH
• E-selektin biosyntéza   MeSH
• fibrinogen biosyntéza   MeSH
• index tělesné hmotnosti * MeSH
• interleukin-6 biosyntéza   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mediátory zánětu MeSH
• obvod pasu * MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• socioekonomické faktory MeSH
• tělesné váhy a míry MeSH
• zánět etnologie   patofyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Geografické názvy
• Spojené státy americké MeSH
• Názvy látek
• biologické markery MeSH
• C-reaktivní protein MeSH
• E-selektin MeSH
• fibrinogen MeSH
• interleukin-6 MeSH
• mediátory zánětu MeSH