Effect of Marital Status on Years of Life Lost From Metastatic Prostate Cancer According to Race/Ethnicity

INTRODUCTION: It is unknown whether marital status affects years of life lost (YLL) in metastatic prostate cancer (mPCa) according to race/ethnicity. METHODS: Within the SEER database (2004-2021), unmarried and married mPCa patients aged 40-80 years were identified. Age- and sex-matched controls were generated (Social Security Administration life tables and Monte Carlo simulation). YLL were quantified for unmarried and married mPCa patients and controls according to race/ethnicity. Subsequently, multivariable competing risks regression (CRR) models were fitted to assess cancer-specific mortality (CSM) and other-cause mortality (OCM). RESULTS: Among 34,202 mPCa patients, the distribution of unmarried patients according to race/ethnicity was as follows: 7267 (34.0%) in Caucasians; 3680 (57.0%) in African Americans; 1659 (37.0%) in Hispanics; and 478 (24.0%) in Asians/Pacific Islanders. YLL values in unmarried vs. married patients relative to age- and sex-matched population simulated controls, were as follows: 7.7 vs. 5.8 in Caucasians (Δ: 1.9), 9.6 vs. 7.9 in African Americans (Δ: 1.7), 7.9 vs. 6.7 in Hispanics (Δ: 1.2), and 6.3 vs. 4.7 in Asians/Pacific Islanders (Δ: 1.6). In multivariable CRR models, unmarried status independently predicted higher CSM (1.2-fold, p < 0.001) and OCM (1.2-fold, p < 0.001) in Caucasians, only higher CSM in African Americans (1.1-fold, p = 0.008) and in Asians/Pacific Islanders (1.2-fold, p = 0.02), but only higher OCM in Hispanics (1.5-fold, p < 0.001). CONCLUSION: Unmarried mPCa patients exhibited higher YLL values than their married counterparts, relative to age- and sex-matched population simulated controls, across all races/ethnicities. Interestingly, the YLL detriments originated from both CSM and OCM in Caucasians, only CSM in African Americans and Asians/Pacific Islanders, and only OCM in Hispanics.