Exploration of social determinants of health and prostate cancer prevalence in the US: a cross-sectional study of NHANES data from 2003-2010

Danfei Hu ¹ Xiaodong Chen ² Mingyao Li ¹ Huacai Xiong ¹ Xuefeng Lu ² Chen Feng ^2*

• ¹ Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang Province, China
• ² Yinzhou No.2 Hospital, Ningbo, China

Objective: Social determinants of health (SDoH) are increasingly recognized as key factors in addressing health inequities. This study aimed to explore the association between SDoH and risk of prostate cancer (PCa).Methods: We analyzed data from the National Health and Nutrition Examination Survey 2003–2010. PCa diagnosis was based on self-reported questionnaires, while highly-probable PCa was assessed using prostate-specific antigen levels. Multivariate logistic regression, restricted cubic spline, and subgroup analysis were performed. Three models were employed: the crude model (unadjusted), model 1 (adjusted for age and race/ethnicity), and model 2 (further adjusted for body mass index, alcohol consumption, and smoking status).Results: The median age of 5,633 participants was 54 years. A negative association was found between the SDoH score and PCa prevalence (OR = 0.868, 95%CI: 0.786–0.959, p = 0.006). Specifically, a family income-to-poverty ratio < 3 (OR = 0.69, 95%CI: 0.499–0.954, p = 0.029) and lack of healthcare access or reliance on emergency rooms (OR = 0.429, 95%CI: 0.218–0.842, p = 0.017) were independently associated with lower PCa prevalence. In model 2, no significant association was found between SDoH and highly probable PCa. A linear association between SDoH and PCa prevalence was observed. A consistently negative association was noted among participants aged ≥ 60 years, Non-Hispanic Black, Non-Hispanic White, and non-obese individuals.Conclusions: The negative association between SDoH and PCa prevalence is likely attributable to inadequate screening and underreporting, rather than any protective effects. Unfavorable SDoH is not a risk factor for the onset of PCa. This study underscores the importance of addressing disparities in healthcare access and improving equity in PCa screening.