Background: Prostate cancer is the most common cancer in U.S. men, and racial disparities in incidence and mortality persist. Tobacco use has been associated with aggressive histologic grade and mortality; however, population-based cancer registries have limited data on lifetime tobacco use or SHS exposure. Community-level small-area estimates calculated from individual-level survey data offer a useful tool for understanding neighborhood effects, and estimating individual behaviors when direct observation is not feasible. Methods: This project used data on all 2005-2014 incident prostate cancer cases in Philadelphia, a city with high burden from both tobacco use and poverty. Using multi-level models, the odds of death from prostate cancer were estimated in relation to individual case characteristics (age, race, year of diagnosis, and tumor histologic grade) and Census tract-level estimates of tobacco use, using CDC’s 500 Cities small area estimates. Mediation analyses were used to examine whether tobacco use plays a role in the relationship between race and both aggressive histologic grade and prostate cancer related mortality. Results: From 2005-2014, 6% of the 10621 cases died from prostate cancer. Cases residing in Census tracts with higher estimated proportion of adults who smoke were more likely to have aggressive grade tumors, and more likely to die from their cancer. Analyses revealed that aggressive grade partially mediated the relationship between tobacco use and cancer death, and that tobacco use partially mediated the relationship between black race and cancer death. Conclusions: Findings support the utility of small area estimates for investigating area-level influences in exploratory studies.

Citation Format: Ann C Klassen, Russell McIntyre, Maxwell Boamah, Scott Keith, Loni Tabb, Charnita Ziegler-Johnson. Can small area estimates explain variation in cancer outcomes? 500 cities’ tobacco use estimates and prostate cancer mortality in Philadelphia [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D001.