Table C29Geographic variations in prostate cancer screening, incidence, and mortality

Reference Period DesignPopulation Data SourceExposure DefinitionsOutcomesAnalysis/UnitExposure CategoriesOutcome Rate
Lu-Yao, 1994 102 White men 50–70 years old from 9 areas in SEER program(~10% of the USA population)Time trends and geographical variations in the detection and treatment of prostate cancerAge-standardized Incidence; annual % change (EAPC) in rates by calendar yearRegression analysis. Pearson correlation between the average rates of incidence and mortality for each SEER area Area Incidence/100,000
1983-1989The National Center of Health Statistics Unit: Patient 1983
Retrospective cohort; ecologic analysis. Risk adjustment: AgeAtlanta279.4
Evidence II2BConnecticut235.0
Quality: 0.7Detroit284.6
Hawaii281.3
Iowa251.0
New Mexico284.6
San Francisco249.3
Seattle348.9
Utah326.7
1989
Atlanta384.5
Connecticut267.9
Detroit361.7
Hawaii502.3
Iowa332.3
New Mexico351.9
San Francisco368.2
Seattle606.8
Utah374.1
Annual % change in rate
Atlanta7.7 (4.1–11.3)
Connecticut2.7 (0.6–4.8)
Detroit5.2 (3.2–73)
Hawaii10.0 (4.3–15.9)
Iowa5.0 (3.6–83)
New Mexico3.0 (0 8–5.3)
San Francisco6.6 (5.0–8.3)
Seattle12.0 (8.8–15.2)
Utah3.0 (0.3–5.7)
Kafadar, 1997 103 The U.S. Census population from 1953-1987Time trends and geographic location by U.S. counties. The proportion of African-AmericansAge-standardized mortality among whites and nonwhitesBivariate smoothing using calculation of age-specific rates; United States Area Mortality/100,000
1953-1987The state Cancer Control Maps; The National Center of Health Statistics Risk adjustment: age, proportion of African Americans 1953-1972, Whites
Ecologic analysisMidwest18.9–23.57
Evidence II2BNortheast18.93–24.17
Quality: 0.9South17.16–22.02
West18.45–23
1953-1972, Not Whites
Midwest16.34–39.12
Northeast0–45.98
South28.29–44.33
West6.31–30.69
1973-1987, Whites
Midwest20.01–24.01
Northeast20.5–25.59
South18.73–23.32
West20.06–26.86
1973-1987, Not Whites
Midwest12.18–45.97
Northeast9.14–42.47
South29.92–51
West17.96–32.8
Jemal, 2002 104 Population estimates in the U.S. for the years 1970-1989 by 5-year age groupsGeographic locations, raceindirectly age-adjusted mortalitySpatial scan statistic; Poisson distribution Areas Age adjusted mortality/100,000 person years
1970-1989U.S. Bureau of Census; The National Center for Health Statistics Unit: Counties White males Rate Rate ratio P value
Ecologic analysis Risk adjustment: education and agricultural employment(United States)20.21-
Evidence II2BNorthwest quadrant21.51.0640.0001
Quality: 0.85New England21.31.0550.0001
Maryland, Virginia, Pennsylvania21.71.0740.0001
Michigan, Ohio, Indiana, Illinois20.81.0280.0001
South Carolina, North Carolina221.090.0027
Montana, North Dakota, Wyoming23.21.1470.0001
Minnesota, Iowa, Wisconsin22.81.1260.0001
California, Oregon21.91.0840.0001
Washington, Oregon21.61.0680.0005
Utah, Nevada, Colorado, Arizona22.41.1070.017
Iowa, Missouri25.31.2490.0235
Vermont, New Hampshire, Maine22.81.1260.0001
Massachusetts, Rhode Island231.1390.0001
Massachusetts, Connecticut21.61.070.0194
Maryland, Delaware22.61.1160.0001
Kentucky, Ohio, Indiana231.1350.0001
Wisconsin21.50.0033
Black Males
(United States)28.61-
South Atlantic31.91.1140.0001
Alabama33.31.1610.005
Ohio, Indiana, Michigan, Kentucky30.81.0770.0561
North Carolina, South Carolina33.71.1770.0001
Florida, Georgia33.71.1770.0001
Maryland, Virginia, Delaware33.21.160.0001
Georgia, North Carolina32.71.1420.0001
Georgia37.81.3190.02
Jemal, 2005 105 40% of the U.S. male population ages 40 years for 1995 to 2000Geographic locations; race, degree of urbanization as a proxy for access to medical careAverage age adjusted to the year 2000 U.S. population standard incidence and mortality rates/100,000 menPoisson distribution Location Age adjusted mortality/100,000
1995-2000The National Center for Health Statistics and the North American Association of Central Cancer Registries (SEER) Unit: States White men
Retrospective cohort, ecologic analysis Risk adjustment: age and raceAlaska258.2
Evidence II2BArizona215.9
Quality: 0.85Colorado274.4
Connecticut332.4
District of Columbia320.5
Atlanta311.4
Hawaii315.3
Idaho283.9
Illinois278.7
Iowa297.1
Kentucky220.0
Louisiana302.0
Maine296.2
Massachusetts353.8
Michigan320.1
Montana278.1
Nebraska308.7
New Hampshire287.3
New Jersey330.1
North Carolina271.2
North Dakota357.4
Oregon298.9
Pennsylvania296.6
Rhode Island266.8
South Carolina286.9
Utah385.8
Washington298.8
West Virginia250.7
Wisconsin318.2
Wyoming279.0
Black men
Arizona154.8
Colorado172.6
Connecticut167.6
District of Columbia164.2
Atlanta169.9
Illinois167.4
Iowa180.3
Kentucky155.2
Louisiana164.4
Massachusetts142.9
Michigan153.7
Nebraska142.5
New Jersey167.2
North Carolina196.7
Oregon177.3
Pennsylvania172.7
Rhode Island129.2
South Carolina195.9
Washington146.6
West Virginia170.1
Wisconsin145.1
White men Incidence of localized PC
Alaska258.2
Arizona215.9
Colorado274.4
Connecticut332.4
District of Columbia320.5
Atlanta311.4
Hawaii315.3
Idaho283.9
Illinois278.7
Iowa297.1
Kentucky220.0
Louisiana302.0
Maine296.2
Massachusetts353.8
Michigan320.1
Montana278.1
Nebraska308.7
New Hampshire287.3
New Jersey330.1
North Carolina271.2
North Dakota357.4
Oregon298.9
Pennsylvania296.6
Rhode Island266.8
South Carolina286.9
Utah385.8
Washington298.8
West Virginia250.7
Wisconsin318.2
Wyoming279.0
Black men
Alaska457.7
Arizona255.9
Colorado363.4
Connecticut500.5
District of Columbia516.2
Atlanta481.5
Hawaii351.8
Illinois386.5
Iowa485.2
Kentucky317.4
Louisiana381.8
Massachusetts487.6
Michigan561.9
Nebraska389.7
New Jersey494.8
North Carolina380.7
Oregon384.6
Pennsylvania483.1
Rhode Island309.3
South Carolina454.6
Utah475.8
Washington421.2
West Virginia400.8
Wisconsin511.6
Escobedo, 2004 106 3,274 African American men in Connecticut, Iowa, and New Mexico diagnosed with localized or regional prostate cancer in 1979-1998Time trends in periods before (1979-1986), during (1987-1990) and after introduction of the PSA test (1991-1998); geographic locationsAge-adjusted to the 1970 U.S. standard incidence and mortalityPoisson distribution. Time and regions
1979-1998The National Center for Health Statistics (NCHS), SEER database Unit: patients Connecticut Incidence Rate
Retrospective cohort Risk adjustment:: age; direct method of standardization to 1970 U.S. population 1973-1988 Rate Ratio
Evidence II2B <543.8
Quality: 0.75 55–64210.3
65–74721.5
>751157.3
1989-1998
<5413.73.61
55–64567.22.7
65–7414502.01
>751495.21.29
1973-1988
By stage
Local/regional63
Distant36
Unstaged10.9
1989-1998
Local/regional158.12.51
Distant26.10.73
Unstaged23.52.16
Overall
Before PSA109.9
During PSA207.81.89
Iowa
1973-1988
<544
55–64211.7
65–74654.2
>751275.1
1989-1998
<54133.25
55–64512.12.42
65–741253.61.92
>751589.91.25
1973-1988
By stage
Local/regional66.3
Distant36.7
Unstaged7.5
1989-1998
Local/regional141.12.13
Distant28.60.78
Unstaged24.13.21
Overall
Before PSA110.6
During PSA193.81.75
New Mexico
1973-1988
<543.5
55–64257.7
65–74475.5
>751195.4
1989-1998
<546.71.91
55–642951.14
65–741093.72.3
>75978.30.82
1973-1988
By stage
Local/regional69.4
Distant22.6
Unstaged8.4
1989-1998
Local/regional115.91.67
Distant15.20.67
Unstaged50.6
Overall
Before PSA100.4
During PSA136.11.36
Connecticut Age adjusted mortality
1979-198678.2 (65.9–90.6)
1987-199081.2 (65.1–97.3)1.04
1991-199893.1 (82.3–103.8)1.19
Iowa
1979-198679.5 (55.1–103.9)
1987-1990111.1 (71.9–150.3)1.4
1991-199893.5 (69.1–117.9)1.18
New Mexico
1979-1986104.7 (69.4–140.0)
1987-199062.1 (26.9–97.4)0.59
1991-199847.6 (29.6–65.5)0.45
Lu-Yao, 2002 107 215,521 males Medicare beneficiaries from the Seattle (94 900) and Connecticut (120,621) identified in the SEER databaseGeographical variations in the detection and treatment of prostate cancerProstate cancer mortality, incidence, and screening intensity(prostate biopsies and PSA)Poisson distributionSeattle Connecticut PSA rate ratio
1987-1997 Unit: patientsSeattle Connecticut5.39 (4.76–6.11)
Retrospective cohort Risk adjustment:: age; race, area of residence, study year, and an age-race interactionSeattle Connecticut1 (reference)
Evidence II2B Biopsy rate ratio
Quality: 0.78 2.2 (1.81–2.68)
1 (reference)
Age adjusted mortality rate ratio
1.03 (0.95–1.11)
1 (reference)

From: Appendix C, Evidence Tables and Figures

Cover of Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer
Comparative Effectiveness of Therapies for Clinically Localized Prostate Cancer [Internet].
Comparative Effectiveness Reviews, No. 13.
Wilt TJ, Shamliyan T, Taylor B, et al.

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