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Show Table 1. Bivariate analyses of selected factors by LDS Status and Religiosity Religiously Active LDS Religiously Less Active LDS Non-LDS X2 P value Age at Diagnosis 40-49 50-59 60-69 70-79 80+ Race White, Non-Hispanic Hispanic Other Marital Status at Diagnosis Never Married Married (cohabitating) Previously Married Unknown Summary Stage (Pathological) Localized Regional Distant Unknown Histological Grade Low (well-differentiated) Medium (moderately diff.) High (poorly diff./undiff.) Unknown Prostate Cancer Primaries Single Single and first of multiple Radiation Therapy No Yes Surgery None/TURP/Simple Prost. Radical Prostatectomy Other Surgery Year of Diagnosis 1985-88 1989-92 1993-96 1997-99 No. 84 677 2513 3023 1170 7373 69 25 92 6493 496 386 4284 1937 433 813 1556 3834 1539 538 6880 587 5720 1747 4294 2960 213 1295 2312 2119 1741 No. 1.1 33 9.1 335 33.6 1174117 40.5 1 15.7 335 98.8 2977 0.9 55 0.3 16 1.2 129 87.0 2340 6.6 386 5.2 193 57.4 1737 25.9 765 5.8 245 10.9 301 20.8 609 51.4 1563 20.6 675 7.2 201 92.1 2778270 7.9 76.6 2373 23.4 675 57.5 1843 39.6 1109 2.9 96 17.3 574 31.0 838 28.4 889 23.3 747 1.1 11.0 38.5 38.4 11.0 97.7 1.8 0.5 4.2 76.8 12.7 6.3 57.0 25.1 8.0 9.9 20.0 51.3 22.2 6.6 91.1 8.9 77.8 22.2 60.5 36.4 3.1 18.8 27.5 29.2 24.5 No. 44 370 1046 1253 387 2700 259 141 164 2332 386 218 1793 741 248 318 619 1535 714 232 2819 281 2426 674 1903 1099 98 510 850 931 809 1.4 11.9 33.7 40.4 12.5 87.1 8.4 4.5 5.3 75.2 12.5 7.0 57.8 23.9 8.0 10.3 20.0 49.5 23.0 7.5 90.9 9.1 78.3 21.7 61.4 35.4 3.2 16.5 27.4 30.0 26.1 <.001 <.001 <.001 <.001 0.079 0.066 0.122 <.001 <.OO1 progression of prostate cancer.28"30 Given that cigarette smoking prevalence in Utah was similar between religiously less active LDS and non-LDS, and assuming that cigarette smoking is associated with poorer survival among prostate cancer patients, our results are unclear. Perhaps because of the fact that cigarette smoking is highly discouraged in the LDS Church, smoking has stronger implications in terms of social support among LDS. Other factors may also be implicated. For example, a recent study showed that LDS who attended church less than weekly were the least physically active in Utah and had the lowest levels of education.27 Although better understanding the role of these factors requires assessment using epidemiologic investigation, it may be suggestive that physical activity slows the progression of the disease, hi addition, higher education may be related to lifestyles that also slow the progression of prostate cancer. Summary stage and histologic grade were the most important independent predictors of disease-specific survival. Although we attempted to capture their influence, some unaccounted for length and lead-time biases may have remained/1 Further, a comorbid disease variable was not available for conditions in general. Previous research has shown that comorbid disease is related to poorer all-cause and prostate cancer-specific survival.4 Relatively low smoking levels among religiously active LDS likely resulted in lower comorbid disease. We were concerned with the degree of accurate assignment of the cause of death, but the influence of inaccurate specification of cancer death appeared to be very small. Bias may result when considering multiple cancer primaries in that religiously active LDS are less likely to smoke cigarettes. Hence, they are less likely to get a cancer related to smoking, which cancers tend to be more lethal (e.g., lung and pancreatic cancers). There would have been a selection bias if we had considered death from any cancer. However, limiting disease-specific death to prostate cancer made the groups more comparable with respect to smoking history. We also considered, although not reported above, proportional hazards among prostate cancer cases for two other scenarios: cases with a single cancer primary and death from any cause of cancer (underlying cause of death codes 140.0 througli 209.9) and cases with a single cancer primary and death from prostate cancer. Results based on these two other approaches were consistent with those reported above. A randomized trial involving Tib, Tic, and T2 prostate cancer cases has shown that radical prostatectomy compared with watchful waiting significantly reduced prostate-specific mortality but not all cause mortality.7 hi the adjusted Cox proportional hazards model estimating the death hazard for any cancer among prostate cancer cases diagnosed with a single primary, the hazard ratio for radical prostatectomy compared with no surgery/transurethral resection/simple prostatectomy was 0.20 (chi-square p < 0.001). Yet, because healthier individuals are typically recommended for aggressive treatment,32 selection bias may explain some of the better survival observed in this group. The fact that religiously active LDS were more likely to undergo radical prostatectomy is consistent with their having better health status, possibly related to higher levels of marriage and lower levels of smoking. Utah's Health: An Annual Review Volume LX 17 |