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Overall environmental quality and prostate cancer characteristics#
Citation:
Jagai, J., A. Patel, D. Lobdell, D. Greenwald, AND M. Abern. Overall environmental quality and prostate cancer characteristics#. American Public Health Administration (APHA) Conference, San Diego, CA, November 10 - 14, 2018.
Impact/Purpose:
The purpose of this study is to utilize EPA's Environmental Quality Index to explore prostate cancer outcomes associated with environmental exposures.
Description:
Prostate cancer (PC) is one of the most common cancer types in the United States (U.S.) Cumulative environmental exposures have been associated with PC incidence. However, the impact of cumulative environmental exposures on PC aggressiveness is not well understood. To address this gap, we utilize the U.S. Environmental Protection Agency’s (USEPA) Environmental Quality Index (EQI) to estimate county-level environmental quality in the U.S. The EQI captures exposure to over 200 environmental factors across five environmental domains (air, water, land, sociodemographic, and built) for 2000-2005. For persons diagnosed with PC from 2010-2014 (n=252,313), prostate specific antigen (PSA), biopsy Gleason score (bGS) and individual level covariates (age, marital status, sex, race) were abstracted from the Surveillance, Epidemiology, and End Results Program (SEER) and linked to the EQI based on place of residence. PSA, which is a measure of protein produced by the prostate gland and used as a screening tool, was dichotomized (PSA>=20 vs. <20). bGS, which is a score used to assess the aggressiveness of PC, was also dichotomized (high grade vs. low grade). We used a mixed effects logistic regression to model with EQI and domain-specific indices as quartiles (Q; Q4 worst environment or worst domain-specific representation) to estimate the OR and 95% CI for PC characteristics adjusting for individual-level covariates. PSA at diagnosis was not associated with overall environmental quality (EQIQ4: OR=0.96(0.86,1.06)). Overall environmental quality was positively associated with increased odds of more aggressive PC as measured by bGS (EQIQ4: OR=1.14(1.02,1.28)) with the strongest associations seen in the sociodemographic (SDQ4: OR=1.26(1.14,1.39)) and built (BQ4: OR=1.14(1.02,1.27)) domains. These results suggest associations between poor environmental quality and more aggressive PC at diagnosis. However, additional research is required to understand specific environmental drivers of PC aggressiveness. This abstract does not necessarily reflect EPA policy. Learning objectives: After the presentation/poster session, the attendant will be able to: 1. Describe the association between overall environmental quality and characteristics of prostate cancer. 2. Describe the association between domain specific indices or environmental quality and characteristics of prostate cancer. 3. Understand how the association between overall environmental quality and prostate cancer characteristics varies by rural-urban status.