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Show Utah voter registration lists; these databases are often a source of updated information regarding vital status and/or date of last contact. According to SEER Program standards, follow-up is considered to be current when the Registry documents that a patient has died, or when the Registry documents that a patient was alive within 18 months of the annual anniversary of the date of original cancer diagnosis. By this definition, 97.9% of the patients in the present study were determined to have complete follow-up at the time data were captured for analysis. Linkage of Cancer Data with LDS Church Records UCR records were linked to LDS Church membership records to determine membership in the LDS Church. The linkage process took place under direct supervision of the Church and the UCR and was conducted in the Church's Member and Statistical Records Department. After the records were linked, all personal identifying information was stripped from the database to ensure confidentiality. Records were linked using the probabilistic linking program LinkPro.18 The program calculates probabilities to identify whether a pair of records refers to the same person. Ten variables that were common to both sets of records were used to link the records: first, middle, and last names; birth day; birth month; birth year; gender; zip code; vital status; and maiden name. SOUNDEX versions of the names were used in the matching process, while actual names were used in the review process. Records linked if they matched on at least seven of the ten variables. Ambiguous links and records that matched on six of the ten variables were manually reviewed. There were approximately 120,000 incident cases of cancer identified in the UCR database from 1973 to 1999 and approximately 6.6 million records in the LDS Church database. There were 81,617 (68%) UCR records linked to a Church membership record. Of these linked records, 74,829 (92%) matched on at least seven of the ten variables. LDS Church membership records contain no direct measure of religious activity; however, age-appropriate priesthood office has been used in other studies as a surrogate measure of religious activity for LDS men.19 All religiously active LDS adult men are ordained to the Melchizedek Priesthood. There are three relevant offices of this priesthood: elder, seventy, and high priest. There is no standard age-related policy outlined by the LDS Church for advancement to these offices, although all men initially hold the office of elder. By age 55, men who are deemed worthy and actively participating in the Church usually hold the office of high priest or seventy. Hence, the rules used to designate LDS men as religiously active or less-active in the LDS Church are as follows: men ages 20-54 who held the priesthood office of elder, seventy or high priest were designated as active. Men ages 55 years and older holding the priesthood office of seventy or high priest were designated as religiously active. Data The present study was based on 13,615 microscopically confirmed, actively followed invasive prostate cancer cases (ICDO-2 site code C619) diagnosed in Utah from 1985 through 1999. Cases who had died but had unknown survival, whose cause of death was determined by death certificate or autopsy only, who represented a second or later primary cancer, or who were aged less than 40 years were not included in this number. There were 7,467 (54.8%) religiously active LDS, 3,048 (22.4%) less religiously active LDS, and 3,100 (22.8%) non-LDS. hi addition to LDS membership and religiosity, the following variables were considered: age, race, marital status, summary stage (pathological), histologic grade, number of primary cancers in one individual, and treatment. Age was categorized into five groups: 40-49, 50-59, 60-69, 70-79, and 80 years and older; race/ethnicity was categorized into three groups: White (non-Hispanic), Hispanic, and other; marital status was categorized into four groups: never married, married/cohabitating, previously married, and unknown; and calendar time was categorized into four groups: 1985-88.1989-92,1993-96, and 1997-99. Number of primary cancers in one individual describes the chronology of diagnosis of all primary malignant cancers over the entire lifetime of the person.16 Localized tumors are confined to the prostate gland, regional tumors are spread to contiguous organs or lymph nodes, and distant tumors are spread to remote organs. Histological grade is defined by the SEER Program Coding Manual and by the International Classification of Diseases for Oncology, Second Edition in increasing level of severity as either low grade (well differentiated), medium grade (moderately differentiated), or high grade (poorly differentiated).1216 These categories are approximately equivalent to the more widely used Gleason grading system as Gleason score 2-4 (low), 5-7 (medium), and 8-10 (high).16 Treatment was defined as follows: radiation as a first course of cancer-directed therapy, radical prostatectomy and other surgery as a first course of cancer-directed therapy, or conservative management (no radiation or cancer-directed surgery and surgery that is non-curative but intended to alleviate symptoms - palliative).16 Statistical Analysis Survival time was calculated as the time interval between diagnosis and date of last information. For deceased cases, the date of last information was the date of death. For cases not known to be deceased, the date of last information was the date that the case was last known to be alive. Cases with death from prostate cancer (ICD-9-CM site code 185 and CD-10-CM site code C61) were the outcome of interest, and all other cases were censored at the time of last information. We estimated prostate cancer-specific survival for cases where prostate cancer is a single cancer primary or the first of multiple cancer primaries. Survival estimates were calculated by the Kaplan-Meier method and the Cox proportional hazards method with one-month intervals.20"22 Statistical difference hi survival curves were determined using the log-rank chi-square test. Statistical significance based on Cox proportional hazards was determined using the Wald chi-square test. The appropriateness of the Cox proportional hazards model was assessed graphically. Two-sided tests of significance were based on the 0.05 level. Statistical analyses were conducted using Statistical Analysis System (SAS) software, version 8.2.23 RESULTS Frequency distributions of selected characteristics by LDS status and religiosity (among LDS) are presented in Table 1. Religiously active LDS had a significantly larger percentage of their population aged 80 years and older, married, not diagnosed with distant stage disease, and treated with radical prostatectomy. LDS compared with non-LDS cases were more likely to be white, non-Hispanic. Of the 13,615 cases, 1,475 (10.8%) died of prostate cancer. Kaplan-Meier prostate cancer-specific survival for cases diagnosed from 1985 through 1999 is shown according to LDS status in Figure 1. The survival curves significantly differ among religiously active LDS. religiously less active LDS, and non-LDS (Log-rank = 20.3, p < 0.001). Across calendar time, religiously active LDS display the best survival and religiously less active LDS display the worst survival. Utah's Health: An Annual Review Volume LX 15 |