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Prostate cancer

Understanding geographic and racial/ethnic disparities in mortality from four major cancers in the state of Georgia: a spatial epidemiologic analysis, 1999–2019

Cancer mortality rates by hot spot areas and county-level associated factors

In Georgia, from 1999 and 2019 there were an overall 162,387 cancer deaths observed among adults aged 18 and older; with approximately 24,395 deaths attributed to breast cancer; 29,577 deaths from colorectal cancer, 91,859 deaths from lung cancer, and 16,556 deaths from prostate cancer (Table 1). For all cancers, both crude and age-adjusted mortality rates were higher in the identified hot spot counties when compared to non-hot spot counties. We additionally provided an interactive dashboard for hot spots overall for breast (Supplemental Fig. 10), colorectal (Supplemental Fig. 11), lung (Supplemental Fig. 12), and prostate (Supplemental Fig. 13) [Note: Supplemental Figs. 1013 are also presented in static form as Fig. 1A–D].

Table 1 Patterns of county-level community health risk factors and behaviors by cancer mortality hot spot classification, stratified by cancer types among all adults in Georgia 1999–2019.
Figure 1
figure 1

Hot spots of cancer mortality stratified by major cancer types: breast, colorectal, lung, and prostate among all adults in Georgia counties from years 1999 through 2019.

Among all Georgia women, we identified 8 of 159 (5.0%) counties as hot spots for breast cancer mortality, with the majority located within central to east Georgia (Fig. 1A). The hot spots counties (43.6 deaths per 100,000 women, 95% CI: 39.0–48.8) had higher rates than non-hot spots (34.4 deaths per 100,000 women, 95% CI: 33.4–35.4), a higher proportion of NH-black population (41.0% vs. 27.6%, p value = 0.01, ρ correlation = 0.20), and a lower proportion of adults with some college education (50.2% vs. 41.6%, p value = 0.05, ρ correlation = − 0.15) when compared with non-hot spot counties.

We also identified 13 of 159 (8.2%) counties in Georgia as hot spots for colorectal cancer mortality, with one cluster ranging from the north-eastern Piedmont region to eastern Coastal Plains region: and another cluster in southwestern Georgia just south of Columbus (Fig. 1B). Colorectal cancer hot spots had higher proportions of NH-black population (41.9% vs. 27.5%, p value < 0.01, ρ correlation = 0.27), residents aged 65 and older (20.9% vs. 17.0%, p value =  < 0.01, ρ correlation = 0.26), lower median household income ($38,352 vs. $44,498, p value < 0.01, ρ correlation = − 0.26), and rural population (75.0% vs. 60.7%, p value = 0.02, ρ correlation = 0.19); but lower proportion of population with some college education (37.4% vs. 51.0%, p value < 0.01, ρ correlation = − 0.25) when compared with non-hot spot counties.

For lung cancer mortality, we identified 8 of 159 (5.0%) counties in Georgia as hot spots, with hot spots identified in four separate quadrants of the state (Fig. 1C). Lung cancer mortality hot spots had higher population aged 65 and older (21.2% vs. 17.0%, p value =  < 0.01, ρ correlation = 0.22). Though non-significant, lung cancer hot spots had marginally higher proportions of NH-white population (83.2% vs. 61.5%, p value = 0.07, ρ correlation = 0.15), and rural population (70.3% vs. 61.6%, p value = 0.20, ρ correlation = 0.10) when compared with non-hot spot counties.

Among all Georgia men, we identified 11 of 159 (6.9%) counties as hot spots for prostate cancer mortality, similarly clustered as colorectal cancer, with one cluster ranging from the north-eastern Piedmont region to eastern Coastal Plains region: and another cluster in southwestern Georgia just outside of Albany, Georgia (Fig. 1D). Prostate cancer hot spot counties had significantly higher proportion of NH-black population (41.9% vs. 27.5%, p value < 0.01, ρ correlation = 0.31), and lower median household income ($38,187 vs. $44.301, p value < 0.01, ρ correlation = − 0.27) when compared with non-hot spot counties. Though non-significant, prostate cancer hot spots had more rural population (68.6% vs. 61.4%, p value = 0.15, ρ correlation = 0.11) when compared with non-hot spot counties.

Mortality rates by hot spot areas, among non-Hispanic white adults

Among NH-white adults, there were a total of 15,507 deaths attributed to breast cancer, 19,572 deaths attributed to colorectal cancer, 70,938 deaths attributed to lung cancer, and 9,631 deaths attributed to prostate cancer from 1999 through 2019 (Table 2). For all cancers, both crude and age-adjusted mortality rates were higher in the identified NH-white hot spots when compared to non-hot spot counties.

Table 2 Patterns of county-level community health risk factors and behaviors by cancer mortality hot spot classification, stratified by cancer types among non-Hispanic white adults in Georgia 1999 – 2019.

County-level associated factors, among non-Hispanic white adults

When stratified by NH-white women, we identified 9 of 159 (5.7%) hot spot counties for breast cancer mortality, with the majority located southwest of Atlanta, eastern Piedmont region, and one county (Towns, Georgia) in Northeastern Blue Ridge region (Fig. 2A). There were no significant differences in county-level factors between NH-white breast cancer hot spots and non-hot spot counties.

Figure 2
figure 2

Hot spots of cancer mortality stratified by major cancer types: breast, colorectal, lung, and prostate among non-Hispanic white adults in Georgia counties from years 1999 through 2019.

Among NH-white adults, we identified 7 of 159 (4.4%) hot spot counties for colorectal cancer mortality, with most hot spots located in the Piedmont region of Eastern Georgia through the Coastal Plain region of southeastern Georgia (Fig. 2B). Colorectal cancer hot spots among NH-white adults had higher proportion of adult smoking (20.2% vs. 18.2%, p value = 0.02, ρ correlation = 0.19) when compared to non-hot spot counties. Though non-significant, there was marginally higher proportion of rural population (74.5% vs. 61.1%, p value = 0.14, ρ correlation = 0.12) and lower median household income ($39,048 vs. $43,723, p value = 0.11, ρ correlation = − 0.13) and in the NH-white colorectal cancer hot spots.

Among NH-white adults, we identified 7 of 159 (4.4%) hot spot counties for lung cancer mortality, with hot spots in three separate quadrants but predominantly in Southwestern Georgia (Fig. 2C). Lung cancer hot spots among NH-white adults had lower median household income ($34,984 vs. $43,723, p value < 0.01, ρ correlation = − 0.23) when compared to non-hot spot counties. Though non-significant, there was marginally higher proportion of population with limited access to healthy foods (12.0% vs. 5.8%, p value = 0.06, ρ correlation = 0.15) in NH-white lung cancer hot spots.

For NH-white men, we identified 8 of 159 (5.0%) hot spot counties for prostate cancer mortality, similarly clustered as colorectal cancer, with hot spots in three separate quadrants but predominantly in the Augusta area and Northeastern Blue Ridge region (Fig. 2D). There were no significant differences in county-level factors between NH-white prostate cancer hot spots and non-hot spot counties.

Mortality rates by hot spot areas, among NH-black adults

Among NH-blacks, there were a total of 7,963 deaths attributed to breast cancer, 8,998 deaths attributed to colorectal cancer, 19,488 deaths attributed to lung cancer, and 9,631 deaths attributed to prostate cancer from 1999 through 2019 (Table 3). For all cancers, both crude and age-adjusted mortality rates were higher in the identified NH-black hot spots when compared to non-hot spot counties.

Table 3 Patterns of county-level community health risk factors and behaviors by cancer mortality hot spot classification, stratified by cancer types among NH-black adults in Georgia 1999–2019.

County-level associated factors, among NH-black adults

When stratified by NH-black women, we identified 9 of 159 (5.7%) hot spot counties for breast cancer mortality, with the majority in metro-Atlanta and 40 miles east of Atlanta (Fig. 3A). NH-black breast cancer hot spots had lower median household income ($51,205 vs. $42,803, p value = 0.15, ρ correlation = − 0.08) when compared with non-hot spots. There were no significant differences in county-level factors between NH-black breast cancer hot spots and non-hot spot counties.

Figure 3
figure 3

Hot spots of cancer mortality stratified by major cancer types: breast, colorectal, lung, and prostate among NH-black adults in Georgia counties from years 1999 through 2019.

Among NH-black adults, we identified 6 of 159 (3.8%) hot spot counties for colorectal cancer mortality, with most hot spots located in the Piedmont region in eastern Georgia or within southwestern Georgia (Fig. 3B). NH-black colorectal cancer hot spots had a higher proportion of population aged 65 and older (22.3% vs. 17.1%, p value = 0.03, ρ correlation = 0.17) when compared to non-hot spot counties. Though non-significant, there was marginally lower proportion of college educated population (47.8% vs. 50.2%, p value = 0.25, ρ correlation = − 0.09) and the median household income was ($43,679 vs. $41.233, p value = 0.29, ρ correlation = − 0.08) lower in NH-black colorectal cancer hot spots compared with non-hot spots among NH-black adults.

Among NH-black adults, we identified 11 of 159 (6.9%) hot spot counties for lung cancer mortality, with hot spots in three separate quadrants including the eastern Piedmont region, southwestern Georgia, and the Ridge and Valley region located in northwestern Georgia (Fig. 3C). Lung cancer hot spots among NH-black adults had higher prevalence of population aged 65 and older (20.9% vs. 17.0%, p value < 0.01, ρ correlation = 0.23); and though non-significant, a higher proportion of population with limited access to healthy foods (11.5% vs. 5.8%, p value = 0.09, ρ correlation = 0.13) when compared to non-hot spots. NH-black lung cancer hot spots had significantly less population with some college education (38.2% vs. 50.5%, p value = 0.03, ρ correlation = − 0.18) when compared to non-hot spots.

When stratified by NH-black men, we identified 9 of 159 (5.7%) hot spot counties for prostate cancer mortality, with hot spots predominantly in the Augusta area and eastern Piedmont to Coastal Plain regions (Fig. 3D). NH-black hot spots were characterized by marginally higher proportion of population with lower proportion of adult obesity (28.7% vs. 34.7%, p value = 0.02, ρ correlation = − 0.18); and though non-significant, there was a higher proportion of NH-black residents (40.8% vs. 27.6, p value = 0.12, ρ correlation = 0.12) and greater proportion of rural residents (70.6% vs. 61.4%, p value = 0.14, ρ correlation = 0.12).

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