# Association of Black race with prostate cancer-specific and other-cause mortality

Source: https://onco.cc/key-papers/paper-dess-black-race-prostate-mortality-jama-oncol-2019/  
OnCo record `paper-dess-black-race-prostate-mortality-jama-oncol-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Black men in the United States are more likely to die of prostate cancer. This study looked at registry data, an equal-access health system and randomised trials together, and found that once treatment and access were equal, the difference in prostate cancer deaths largely disappeared. The difference in dying of everything else did not.

## Summary

Robert Dess, Daniel Spratt and colleagues assembled individual patient data on men with clinical T1 to T4, N0 to N1, M0 prostate cancer from three cohorts with progressively tighter control of access: the Surveillance, Epidemiology, and End Results registry (296,273 men), five equal-access Veterans Affairs medical centres (3,972 men, all treated surgically) and four pooled National Cancer Institute randomised radiotherapy trials (5,854 men). Inverse probability weighting was used to adjust for demographic, cancer and treatment differences.

The gradient across the three cohorts is the finding. In the registry, Black race carried an age-adjusted subdistribution hazard ratio for prostate cancer death of 1.30; after adjustment it fell to 1.09, with no significant difference in high-risk men. In the equal-access surgical cohort there was no significant difference, and in the randomised trials Black men had a significantly lower hazard. Other-cause mortality remained significantly higher in two of the three cohorts.

## Fields

- Kind: Key paper
- Last checked: 2026-09-25
- Also known as: Dess 2019; Black race prostate cancer mortality equal access
- Tags: prostate-evidence
- Journal: JAMA Oncology
- Year: 2019
- DOI: 10.1001/jamaoncol.2019.0826
- Authors: Dess RT, Hartman HE, Mahal BA, et al.
- Findings: In the SEER cohort, Black race was associated with an age-adjusted subdistribution hazard ratio for prostate cancer-specific mortality of 1.30 (95 percent confidence interval 1.23 to 1.37; P less than 0.001).; After inverse probability weighting, the increase in prostate cancer-specific mortality at 10 years was 0.5 percentage points (0.2 to 0.9), subdistribution hazard ratio 1.09 (1.04 to 1.15), with no significant difference in high-risk men (1.04; 0.97 to 1.12; P equals 0.29).; No significant difference in prostate cancer-specific mortality in the weighted equal-access Veterans Affairs cohort (subdistribution hazard ratio 0.85; 0.56 to 1.30; P equals 0.46).; In the weighted randomised trial cohort, Black men had a significantly lower hazard of prostate cancer death (0.81; 0.66 to 0.99; P equals 0.04).; Other-cause mortality was significantly higher for Black men in the weighted SEER cohort (1.30; 1.27 to 1.34; P less than 0.001) and the weighted trial cohort (1.17; 1.06 to 1.29; P equals 0.002).
- What it means: The disparity in prostate cancer death among Black men in the United States is, stage for stage and treatment for treatment, largely a disparity in getting standard care rather than in tumour biology. The disparity that survives equal access is in dying of everything else, which is the part a cancer service is least organised to fix and most able to measure.
- Caveats: Retrospective, even with inverse probability weighting; unmeasured confounding remains, and the trial cohort is a selected population that consented to randomisation.; Higher incidence and younger age at presentation in Black men are not addressed here; the paper is about mortality after diagnosis at a given stage.; United States cohorts and United States health system; the access gradient in other systems is different.

## Sources

- JAMA Oncol 2019: https://doi.org/10.1001/jamaoncol.2019.0826
- PubMed: https://pubmed.ncbi.nlm.nih.gov/31120534/

## Connected records

- key papers: [Trans-ancestry genome-wide association meta-analysis of prostate cancer identifies new susceptibility loci and informs genetic risk prediction](https://onco.cc/key-papers/paper-conti-trans-ancestry-gwas-prostate-nat-genet-2021/), [USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over)](https://onco.cc/key-papers/paper-uspstf-prostate-screening-jama-2018/)
- ideas: [Cardiometabolic screening and treatment for survivors on long-term hormone therapy](https://onco.cc/ideas/idea-acc-cardiometabolic-clinic-hormone-therapy/), [Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity](https://onco.cc/ideas/idea-prostate-other-cause-mortality-as-a-reported-service-outcome/)
- roadmaps: [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- cancers: [Localised prostate cancer, high and very high risk](https://onco.cc/cancers/prostate-high-risk/), [Localised prostate cancer, intermediate risk](https://onco.cc/cancers/prostate-intermediate-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- terms: [Hazard ratio (HR)](https://onco.cc/terms/hazard-ratio/), [Other-cause mortality](https://onco.cc/terms/other-cause-mortality/), [Polygenic risk score (PRS)](https://onco.cc/terms/polygenic-risk-score/), [Screening](https://onco.cc/terms/screening/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Older and multimorbid patients are excluded and undertreated](https://onco.cc/bottlenecks/b-aging-comorbidity/), [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Trials do not represent the people who get cancer](https://onco.cc/bottlenecks/b-trial-diversity/)
- journals: [JAMA Oncology](https://onco.cc/journals/jama-oncology/)

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