PO.PS01.04 · 人群科学
为接受根治性前列腺切除术的前列腺癌患者开发多元社会风险评分
Developing a polysocial risk score for prostate cancer patients treated with radical prostatectomy
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
引言：前列腺癌是美国男性癌症发病和死亡的首要原因，且存在显著的种族差异。即便在考虑临床分期和治疗之后，黑人男性的发病率仍更高、结局仍更差于白人男性。健康的社会决定因素（SDOH）越来越被认为是这些差异的关键驱动因素，其影响贯穿前列腺癌全程诊疗——从筛查到生存期管理。我们开发了一种新型多元社会风险评分，整合多种心理社会及社会经济因素以量化累积的SDOH负担，并在一个前列腺癌队列中评估其与种族、临床特征及社区背景的关联。
方法：我们回顾性识别了126例于2011年至2019年在单一学术癌症中心接受根治性前列腺切除术的前列腺癌患者。11个候选变量——涵盖感知压力、孤独感、经济困难及社会经济地位（教育、收入、就业）——被纳入探索性因子分析。基于因子载荷保留了一个7项单维复合量表（1项压力、3项孤独感、1项经济困难、2项SES），其内部一致性可接受（Cronbach's alpha = 0.74）。我们按自报种族（黑人 vs. 白人）比较多元社会风险评分，并检验其与肿瘤分期、前列腺特异性抗原（PSA）、社会剥夺指数（SDI）及社区集体效能的关联。
结果：最终评分解释了该项目集39.6%的方差，反映出一个内聚的社会风险构念。黑人患者的评分显著高于白人患者（均值2.79 vs. -1.08，p<0.001），表明其累积社会逆境更大。该评分与肿瘤分期无关（p=0.89），提示社会风险负担独立于疾病严重程度。然而，较高的评分与社区弱势（SDI，r=0.52，p<0.001）及较低的集体效能（信任度；r=-0.20，p=0.03）相关。
结论：这一心理社会及社会经济逆境的复合测量指标揭示，尽管临床特征相似，黑人前列腺癌患者的累积社会风险显著更高。多元社会风险评分可能有助于识别存在未满足社会需求、可从针对性支持性干预中获益的患者。将社会风险评估纳入前列腺癌诊疗，或可通过应对导致结局差异的上游决定因素来促进健康公平。
查看英文原文 English abstract
Introduction: Prostate cancer is the leading cause of cancer morbidity and mortality among men in the United States, with stark racial disparities. Black men experience both higher incidence and worse outcomes compared to White men, even after accounting for clinical stage and treatment. Social determinants of health (SDOH) are increasingly recognized as critical drivers of these disparities, influencing care across the prostate cancer continuum-from screening to survivorship. We developed a novel polysocial risk score that integrates multiple psychosocial and socioeconomic factors to quantify cumulative SDOH burden, and evaluated its associations with race, clinical characteristics, and neighborhood context in a prostate cancer cohort.
Methods: We retrospectively identified 126 prostate cancer patients who underwent radical prostatectomy between 2011 and 2019 at a single academic cancer center. Eleven candidate variables-capturing perceived stress, loneliness, financial strain, and socioeconomic status (education, income, employment)-were included in an exploratory factor analysis. A 7-item unidimensional composite (1 stress item, 3 loneliness items, 1 financial strain item, 2 SES items) was retained based on factor loadings and showed acceptable internal consistency (Cronbach's alpha = 0.74). We compared polysocial risk scores by self-reported race (Black vs. White) and examined associations with tumor stage, prostate-specific antigen (PSA), the Social Deprivation Index (SDI), and neighborhood collective efficacy.
Results: The final score accounted for 39.6% of variance in the item set, reflecting a cohesive social risk construct. Black patients had significantly higher scores than White patients (mean 2.79 vs. -1.08, p < .001), indicating greater cumulative social adversity. The score was not associated with tumor stage (p = .89), suggesting social risk burden was independent of disease severity. However, higher scores were correlated with neighborhood disadvantage (SDI, r = 0.52, p < .001) and lower collective efficacy (trust; r = -0.20, p = .03).
Conclusion: This composite measure of psychosocial and socioeconomic adversity revealed markedly higher cumulative social risk among Black prostate cancer patients, despite similar clinical profiles. The polysocial risk score may aid in identifying patients with unmet social needs who could benefit from targeted supportive interventions. Integrating social risk assessment into prostate cancer care may promote health equity by addressing upstream determinants of disparate outcomes.
利益披露 Disclosure
K. Campbell, None..
D. Bae, None..
C. Hughes-Halbert, None.