Table 3.
Multilevel Cox proportional hazards modeling incorporating random intercepts for unobserved county-level variability using the SEER.
| Model 1 | Model 2 | Model 3 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| aHR | p-Value | Upper 99%CI | Lower 99%CI | aHR | p-Value | Upper 99%CI | Lower 99%CI | aHR | p-Value | Upper 99%CI | Lower 99%CI | |
| Race/ethnicity (ref = Non-Hispanic White population) | ||||||||||||
| Non-Hispanic Black population | 1.64 | <0.001 | 1.54 | 1.74 | 1.22 | <0.001 | 1.14 | 1.30 | 1.19 | <0.001 | 1.12 | 1.27 |
| Hispanics | 1.11 | <0.001 | 1.03 | 1.20 | 0.89 | <0.001 | 0.83 | 0.96 | 0.90 | <0.001 | 0.83 | 0.97 |
| Non-Hispanic Asian Pacific Islander population | 0.79 | <0.001 | 0.70 | 0.88 | 0.66 | <0.001 | 0.59 | 0.74 | 0.67 | <0.001 | 0.60 | 0.75 |
| Non-Hispanic American Indian/Alaska Native population |
1.88 | <0.001 | 1.42 | 2.48 | 1.35 | 0.006 | 1.02 | 1.79 | 1.33 | 0.007 | 0.99 | 1.76 |
| Individual-level characteristics | ||||||||||||
| Stage at diagnosis (ref = local) | ||||||||||||
| Regional | 2.74 | <0.001 | 2.50 | 2.98 | 2.74 | <0.001 | 2.51 | 2.99 | ||||
| Distant | 24.78 | <0.001 | 23.44 | 26.18 | 24.74 | <0.001 | 23.42 | 26.14 | ||||
| Gleason Score (ref = GS6) | ||||||||||||
| GS7 | 1.96 | <0.001 | 1.71 | 2.25 | 1.96 | <0.001 | 1.71 | 2.24 | ||||
| GS8 | 4.27 | <0.001 | 3.73 | 4.91 | 4.27 | <0.001 | 3.73 | 4.91 | ||||
| GS9 | 6.92 | <0.001 | 6.07 | 7.86 | 6.90 | <0.001 | 6.06 | 7.86 | ||||
| GS10 | 10.56 | <0.001 | 8.94 | 12.48 | 10.47 | <0.001 | 8.86 | 12.36 | ||||
| Not carried out/unknown | 6.89 | <0.001 | 4.11 | 5.27 | 6.89 | <0.001 | 4.11 | 5.27 | ||||
| Surgery (ref = no) | ||||||||||||
| Yes | 0.54 | <0.001 | 0.50 | 0.58 | 0.54 | <0.001 | 0.50 | 0.58 | ||||
| Year of diagnosis | ||||||||||||
| 2011 vs. 2007 | 0.91 | <0.001 | 0.90 | 0.93 | 0.91 | <0.001 | 0.90 | 0.93 | ||||
| Insurance status at diagnosis (vs. no insurance) |
||||||||||||
| Any Medicaid | 0.68 | <0.001 | 0.59 | 0.79 | 0.68 | <0.001 | 0.59 | 0.79 | ||||
| Insured | 0.44 | <0.001 | 0.38 | 0.50 | 0.44 | <0.001 | 0.39 | 0.50 | ||||
| County-level characteristics | ||||||||||||
| County-level SES (Q5 vs. Q1) | ||||||||||||
| Less than high school | 0.97 | 0.633 | 0.88 | 1.15 | ||||||||
| At least bachelor-level | 0.82 | 0.001 | 0.70 | 0.95 | ||||||||
| Unemployment | 0.96 | 0.273 | 0.87 | 1.06 | ||||||||
| Poverty/Income | 1.10 | 0.091 | 0.95 | 1.27 | ||||||||
| Foreign-born/Language-isolated | 1.14 | 0.043 | 0.96 | 1.36 | ||||||||
| County metro/non-metro | ||||||||||||
| Non-metropolitan (vs. metro) | 1.03 | 0.459 | 0.94 | 1.16 | ||||||||
| County region (vs. West) | ||||||||||||
| Midwest | 1.00 | 0.982 | 0.89 | 1.13 | ||||||||
| Northeast | 0.89 | <0.001 | 0.82 | 0.97 | ||||||||
| South | 1.10 | 0.013 | 0.97 | 1.21 | ||||||||
Model 1: adjusted for marital status and age; Model 2: adjusted for model 1 covariates and clinical and individual-level characteristics; Model 3: adjusted for model 2 covariates and county-level socioeconomic and demographic characteristics; abbreviations: GS = Gleason Score, PCa = Prostate Cancer, Q = Quintile.