Analysis of Prostate Cancer Prevention Behavior in Florida Utilizing The 2002 BRFSS Data Yussif Dokurugu MPH Candidate April 9, 2004

Analysis of Prostate Analysis of Prostate Cancer Prevention Cancer Prevention Behavior in Florida Behavior in Florida Utilizing The 2002 Utilizing The 2002

BRFSS DataBRFSS Data

Yussif DokuruguYussif DokuruguMPH CandidateMPH Candidate

April 9, 2004April 9, 2004

OutlineOutline Background Background Purpose Purpose ObjectivesObjectives MethodologyMethodology ResultsResults ConclusionConclusion LimitationsLimitations RecommendationsRecommendations AcknowledgementAcknowledgement QuestionsQuestions

Background & Epidemiological Background & Epidemiological RelevanceRelevance

Prostate cancer Prostate cancer is a malignant is a malignant tumor of the tumor of the prostate gland, a prostate gland, a walnut-sized walnut-sized organ located in organ located in front of the front of the rectum and right rectum and right below the below the bladderbladder


Prostate Cancer (PC) is the Prostate Cancer (PC) is the single most common form of single most common form of tumor tumor

One new case of PC every three One new case of PC every three minutesminutes

Is present in more than 9 Is present in more than 9 million menmillion men


Kills one man every 13 minutesKills one man every 13 minutes Lacks national awareness Lacks national awareness 2003, 15,800 new PC cases in 2003, 15,800 new PC cases in

FLFL– 2,100 cancer deaths in FL2,100 cancer deaths in FL


Prostate Cancer Prostate Cancer develops in four develops in four stages:stages:– Initiation Initiation – Promotion Promotion – ProgressionProgression– MetastasisMetastasis


SymptomsSymptoms– Frequent urinationFrequent urination– Burning with urinationBurning with urination– Painful ejaculationPainful ejaculation– Blood in urineBlood in urine– Stiffness in lower back and hipsStiffness in lower back and hips


Risk FactorsRisk Factors– AgeAge– RaceRace– Family historyFamily history– DietDiet


Treatment optionsTreatment options– Watchful waitingWatchful waiting– SurgerySurgery– RadiationRadiation– ChemotherapyChemotherapy– Hormonal therapyHormonal therapy

Treatment depends onTreatment depends on– Confinement of cancerConfinement of cancer– Stage of cancerStage of cancer– Metastasis of cancerMetastasis of cancer

PurposePurpose

To examine the preventive To examine the preventive health practices and risk factors health practices and risk factors among men in Florida that are among men in Florida that are associated with the incidence of associated with the incidence of prostate cancer as reported in prostate cancer as reported in the Florida BRFSS data.the Florida BRFSS data.

ObjectivesObjectives

To investigate demographic To investigate demographic factors associated with the factors associated with the prostate cancer prevention prostate cancer prevention behaviorsbehaviors

To examine the impact of health To examine the impact of health insurance and health utilization insurance and health utilization associated prostate cancer associated prostate cancer prevention behaviorsprevention behaviors

MethodologyMethodologyBRFSSBRFSS

State-basedState-based Cross-sectionalCross-sectional Non-institutionalized Non-institutionalized Adult population over the age of 18 Adult population over the age of 18 Developed and supportedDeveloped and supported Centers for Disease Control and Centers for Disease Control and

Prevention (CDC)Prevention (CDC)

MethodologyMethodology

2002 BRFSS2002 BRFSS– Utilized state specific dataUtilized state specific data

Statistical Analysis System (SAS) 9.0Statistical Analysis System (SAS) 9.0 Univariate (Frequencies)Univariate (Frequencies) Bivariate comparisonsBivariate comparisons Multivariate AnalysisMultivariate Analysis

– Logistic Regression analysis for:Logistic Regression analysis for: PSA-TestPSA-Test DR-ExamDR-Exam Prostate cancer incidenceProstate cancer incidence

MethodologyMethodologyBRFSSBRFSS

Designed to monitor trends in:Designed to monitor trends in:– Risk behaviorsRisk behaviors– Chronic diseasesChronic diseases– Prostate cancer conditionsProstate cancer conditions

Response rates vary for subgroupsResponse rates vary for subgroups– State of Florida rates range from 87 State of Florida rates range from 87

to 98 percentto 98 percent

Demographic CharacteristicsDemographic Characteristics

Selected Selected populationpopulation– FloridaFlorida

– Male (18-99)Male (18-99)

– N=2,437N=2,437


Participant Race

White, 78.2

Black, 8.8Hispanic, 13

0

10

20

30

40

50

60

70

80

90

Race

Pe

rce

nta

ge


Participant Age Group

24.2

35.2

15.9

24.7

0

10

20

30

40

Age Group

Per

cen

tage

<35 35-54 55-64 65-99


Marital Status

58%22%

14%

6%

Married

NeverMarriedDivorced

Widowed


Participants Education

6.7

28.230.5

34.6

05

10152025303540

Education

Per

cen

tage

Some High

GED

Some College

College Graduate

Demographic CharacteristicsDemographic CharacteristicsEmployment Status

Employed

Unemployed

Retired

Unable towork


Income Levels23.1

7.6

10.3

18.4

20.819.6

0

5

10

15

20

25

Income

Per

cent

age

<20

<25

<35

<50

<75

>75


Health Plan

83.6%

17.3%

YesNo

Health CharacteristicHealth Characteristic

General Health

24.5

33.4

26.7

9.9

5.5

0

5

10

15

20

25

30

35

40

Health Status

Pe

rce

nta

ge Excellent

Very GoodGoodFairPoor

Health BehaviorHealth BehaviorAny Exercise

25%

75%

YesNo

Health UtilizationHealth Utilization

Health Facility85.2

5.9 3.4 5.6

0

10

20

30

40

50

60

70

80

90

Facility

Per

cen

tage Doctors office

Health Clinic

Hospital

Emergencyroom

ResultsResultsBivariate AnalysisBivariate Analysis

VariableVariable

Yes (%)Yes (%) No (%)No (%)

RaceRace

WhiteWhite

BlackBlack

HispanicHispanic

5.35.3

4.14.1

1.51.5

94.794.7

95.995.9

98.298.2

ResultsResults Bivariate Analysis Bivariate Analysis

VariableVariable

Yes (%)Yes (%) No (%)No (%)

AgeAge

<40<40

>40>40

4.54.5

10.010.095.595.5

90.090.0

ResultsResults Bivariate Analysis Bivariate Analysis

VariableVariable

Yes (%)Yes (%) No (%)No (%)

General HealthGeneral Health

Good Good

FairFair

PoorPoor

4.24.2

6.66.6

8.28.2

95.895.8

93.493.4

91.891.8

ResultsResults

VariableVariable PSA-TestPSA-Test DR-ExamDR-Exam PCPC

RaceRace

WhiteWhite

BlackBlack

HispanicHispanic

1.001.00

1.321.32

0.990.99

1.001.00

1.091.09

0.760.76

1.001.00

1.541.54

0.380.38

Odds Ratios for factors that affect the probability Odds Ratios for factors that affect the probability of being tested and diagnosed for prostate cancer (P<0.05).of being tested and diagnosed for prostate cancer (P<0.05).

ResultsResults


AgeAge

<40<40

>40>401.001.00

3.363.361.001.00

2.792.791.001.00

9.999.99

Odds Ratios for factors that affect the probability of being Odds Ratios for factors that affect the probability of being tested and diagnosed for prostate cancer (P<0.05).tested and diagnosed for prostate cancer (P<0.05).

ResultsResults

VariableVariable PSA-TestPSA-Test DR-DR-ExamExam

PCPC

EducationEducation

ElementaryElementary

High SchoolHigh School

CollegeCollege

1.001.00

1.431.43

2.012.01

1.001.00

1.461.46

2.342.34

1.001.00

0.640.64

1.151.15

Odds Ratios for factors that affect the probability Odds Ratios for factors that affect the probability of being tested and diagnosed for prostate cancer (P<0.05).of being tested and diagnosed for prostate cancer (P<0.05).

ResultsResults


Health PlanHealth Plan

NoNo

YesYes1.001.00

2.372.371.001.00

2.042.041.001.00

4.444.44

Odds Ratios for factors that affect the probability Odds Ratios for factors that affect the probability of being tested and diagnosed for prostate cancer (P<0.05of being tested and diagnosed for prostate cancer (P<0.05).).

ConclusionConclusion

The study shows that African The study shows that African American men have higher American men have higher prostate cancer incidents prostate cancer incidents consistent with other findingsconsistent with other findings

Age, race and education are Age, race and education are important risk factors associated important risk factors associated with prostate cancer incidence.with prostate cancer incidence.

LimitationsLimitations

Non-disease specific dataNon-disease specific data

Analysis of secondary dataAnalysis of secondary data

RecommendationRecommendation

Increase awareness of the Increase awareness of the diseasedisease

- African American Men- African American Men

- Legislature- Legislature

- General community- General community

AcknowledgementsAcknowledgements

IPH Faculty & StaffIPH Faculty & Staff DR. Folakemi OdedinaDR. Folakemi Odedina ESAP Faculty, Staff & Students ESAP Faculty, Staff & Students Good FriendsGood Friends Family Family

QUESTIONSQUESTIONS

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Documents

Analysis of Prostate Cancer Prevention Behavior in Florida Utilizing The 2002 BRFSS Data Yussif Dokurugu MPH Candidate April 9, 2004