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Mediation Analysis to Investigate Differences in Prostate Cancer Diagnosis Stage Through Environmental Risk Factors in Louisiana
by
, , , and
Nubaira Rizvi
1
,
Randy Hamilton
1,
Xiao-Cheng Wu
2,
Michael D. Celestin, Jr.
3,
Tung-Sung Tseng
3
and
Qingzhao Yu
3,* 1
Biostatistics and Data Science, School of Public Health, LSU Health—New Orleans, New Orleans, LA 70112, USA
2
Louisiana Tumor Registry, School of Public Health, LSU Health—New Orleans, New Orleans, LA 70112, USA
3
Community Health Science & Policy, School of Public Health, LSU Health—New Orleans, New Orleans, LA 70112, USA
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2025, 32(8), 416; https://doi.org/10.3390/curroncol32080416
Submission received: 28 April 2025
/
Revised: 7 July 2025
/
Accepted: 20 July 2025
/
Published: 24 July 2025
(This article belongs to the Special Issue New and Emerging Trends in Prostate Cancer)
Simple Summary
Prostate cancer is the most commonly diagnosed cancer in men and a leading cause of cancer deaths. In Louisiana, Black men are more likely than White men to be diagnosed at a later stage of the disease. This study analyzed data from 24,647 prostate cancer patients to explore reasons for this disparity. There is a significant (p-value < 0.001) association between race and stage at diagnosis. It found that both individual factors, like body mass index, marital status, health insurance, and environmental factors, such as exposure to air pollution, proximity to railroads, and asthma rates, affect the observed disparity. Harmful air pollutants like acetaldehyde and general air toxicity were among the key environmental contributors. Together, these factors help explain much of the difference in diagnosis stage between Black and White men. The findings highlight the importance of addressing exposure to environmental hazards and improving healthcare access to reduce racial differences in prostate cancer outcomes.
Abstract
Prostate Cancer (PCa) is the most commonly diagnosed cancer and the second leading cause of cancer death among men. In Louisiana (LA), Black men are disproportionately diagnosed at later stages compared to White men. This study explores environmental risk factors as potential intermediate variables linking race to cancer diagnosis stage. The Louisiana Tumor Registry data included 24,647 male patients diagnosed with PCa in LA between 2010 and 2018. Among them, 15,875 (64.40%) were Caucasian American (CA) and 8772 (35.59%) African American (AA). Mediation analysis using multiple additive regression trees (MART) identified possible intermediate variables that potentially explain the observed disparity. The study found that individual characteristics and environmental factors jointly explained 84% (95% CI: 44.1%, 94.6%) and 18.6% (95% CI: 7.3%, 53.7%) of the observed racial disparity in PCa stage at diagnosis, respectively. Individual factors included BMI (35.9%), marital status (28.5%), CDI (8.2%), female-headed households (2.3%), comorbidity (3.9%), and insurance status (6.3%). Environmental contributors included cancer risk due to air toxicity exposure (7.2%), asthma prevalence (6.6%), acetaldehyde levels (2.1%), railroad proximity (2.1%), walkability (0.3%), and ozone level (−0.1%). Environmental factors jointly played a significant role in the observed racial disparity. The factors such as air toxicity, acetaldehyde levels, and asthma prevalence highlight the need to address industrial pollutants to reduce the differences.
