Rural-Urban Differences and Socioeconomic Disparities in Long-Term Urinary Adverse Events Following Prostate Cancer Treatment

Introduction:Long-term urinary adverse events (UAEs) after prostate cancer (PCa) treatment significantly affect survivor quality of life. Previous research suggests disparities in PCa outcomes across geographic and sociodemographic lines, but a comprehensive analysis of treatment-related UAEs is lacking.Methods:Using SEER (Surveillance, Epidemiology, and End Results)-Medicare data (1999-2019), we conducted a retrospective cohort study of men aged 66 or older with nonmetastatic PCa treated within 12 months of diagnosis. Rural vs urban residence was determined using Rural-Urban Continuum Codes. UAE risk was assessed using multivariable Cox models and competing risks regression, adjusting for demographics, education, income, comorbidities, and treatment type.Results:Among 166,581 patients, rural residents (16% of cohort) showed lower 15-year cumulative UAE incidence compared with urban residents (17% vs 20%; P <.001), despite having lower median per capita income ($18,595 vs $26,343; P <.001) and less education (19% vs 12% without high school education; P <.001). Rural residence was associated with lower UAE rates (adjusted HR [aHR] 0.90, 95% CI, 0.86-0.94). Higher risk was observed among Hispanic (aHR 1.18, 95% CI 1.11-1.25) and non-Hispanic Black patients (aHR 1.11, 95% CI 1.05-1.16), those with lower education (aHR 1.31, 95% CI 1.23-1.39 for lowest vs highest quartile), and patients aged 80 years or older (aHR 1.54, 95% CI 1.47-1.61).Conclusions:Rural residence was unexpectedly associated with lower UAE rates after PCa treatment. However, significant disparities persisted across racial and socioeconomic lines, with higher risks among minority and less educated patients, suggesting complex relationships between geography, demographics, and treatment outcomes.