Geospatial analysis of prostate cancer burden and social vulnerability across the state of Virginia.

Abstract

242 Background: Geographic disparities in prostate cancer outcomes may reflect underlying differences in social vulnerability and healthcare access. We evaluated the relationship between county-level social vulnerability, insurance coverage, and prostate cancer burden across the state of Virginia. Methods: We conducted a population-based study using county-level, age-adjusted prostate cancer incidence and mortality data from the Virginia Cancer Registry. Social vulnerability was measured using the CDC Social Vulnerability Index (SVI).Associations between prostate cancer outcomes and vulnerability measures were evaluated using Spearman correlation and Kruskal–Wallis tests across SVI quartiles. Multivariable ecological regression models with HC3 heteroskedasticity-consistent robust standard errors was used. Results: A total of 133 counties and independent cities were included for incidence analyses and 126 for mortality analyses. High-burden communities were concentrated in Southwest Virginia, Southside Virginia, and the Eastern Shore and frequently exhibited high social vulnerability (SVI >0.84). Median prostate cancer incidence increased from 119.7 per 100,000 in the lowest SVI quartile to 142.9 per 100,000 in the highest quartile, while median mortality increased from 20.8 to 30.3 per 100,000. Mortality was significantly higher in the highest SVI quartile compared with the lowest quartile (adjusted p<0.001), second quartile (p=0.002), and third quartile (p=0.016). SVI was positively correlated with both incidence (ρ=0.235, p=0.006) and mortality (ρ=0.438, p<0.001). Several localities demonstrated disproportionately high mortality relative to incidence, including Lee County (M:I ratio 0.38), Bristol City (0.36), Galax City (0.33), Wise County (0.32), and Manassas City (0.30). In HC3 robust ecological regression models, higher SVI remained independently associated with increased prostate cancer mortality (β=11.2, p<0.001) after adjustment for uninsured rates and rurality. Uninsured rates were not independently associated with mortality, whereas rural counties demonstrated lower mortality than urban counties (β=-3.11, p=0.019). From 2001–2006 to 2019–2022, late-stage prostate cancer presentation increased by ≥5 percentage points across most Virginia counties, with increases of 61.5% in Accomack, 64.0% in Petersburg, 63.2% in Lunenburg, and 82.1% in Nottoway, all highly vulnerable communities. Conclusions: Social vulnerability is a strong predictor of prostate cancer incidence and mortality across the state of Virginia. These areas should be considered as priority targets for screening, early detection, and equitable oncology care delivery.