PROSTATE-CANCER, RACE, AND SOCIOECONOMIC-STATUS - INADEQUATE ADJUSTMENT FOR SOCIAL-FACTORS IN ASSESSING RACIAL-DIFFERENCES

BACKGROUND. This paper reviews the state of the art in analyzing race, social factors, and economic factors in cancer research, with an emph asis on prostate cancer and the role of socioeconomic status (SES) in racial differences in mortality. It analyzes the quality of articles i n the literature that assess the role of SES in cancer mortality. METH ODS. English-language titles were identified using MEDLINE with public ation dates from mid-1985 through July 1994. Articles in the reference s of these articles were also included in the final selection, based o riginally on title and ultimately on content, dating back to 1978. Art icles that included SES information and distinguished between whites a nd African-Americans were chosen, resulting in a final selection of 21 articles. Articles are summarized with consideration of five criteria considered minimal requirements of a well-designed study of the role of race in cancer mortality: (1) SES measure(s) should be on an indivi dual level, not census level; (2) SES should be controlled for when ma king comparisons between whites and blacks; (3) SES should include at least (individual level) measures of income and education; (4) sample sizes are sufficient for the relevant populations; and (5) specific ca ncer sites should be studied separately. RESULTS. Of the articles revi ewed, only two meet the minimum standards, neither of which studied pr ostate cancer. It is not clear whether observed racial differences in prostate cancer are directly attributable to race or reflect underlyin g social factor differences between whites and African-Americans. CONC LUSIONS. In the future, specific characteristics of SES should be meas ured at the individual level; there is a need for expansion and standa rdization of data in terms of social and economic content; other metho dological advances are needed in modeling to take into consideration t he influence of SES in outcome research related to cancer. (C) 1996 Wi ley-Liss, Inc.