Key messages
Contents

Inequalities in prostate cancer mortality in England: The role of ethnicity and socioeconomic deprivation

November 2025 

Data & Evidence, Prostate Cancer UK  

Key messages

  • In England, there are clear ethnic inequalities in prostate cancer mortality, and some men are more likely to die from prostate cancer than others. Black men as a population die from prostate cancer more often than men of other ethnicities. 

  • There are differences in prostate cancer mortality rates within major ethnic groups. Black Caribbean men have a higher prostate cancer mortality rate when compared to Black African men. The reasons behind these discrepancies are unknown and need to be further explored.  

  • Across all ethnic groups, prostate cancer mortality rates increased with deprivation, being highest in the most deprived quintile. However, at every level of deprivation, Black Caribbean men had the highest mortality rates than men of other ethnicities. 

  • These findings suggest that socioeconomic factors alone cannot explain ethnic disparities in prostate cancer mortality. Systemic inequities and cultural differences could also play a role. 

  • Recommendations include addressing systemic inequities in healthcare at both policy and clinical levels, implementing targeted awareness and early detection initiatives for high-risk groups, and improving the quality and representation of ethnicity data to enable more robust analyses. 

Introduction

Prostate cancer is the most common cancer in England, with over 63,000 diagnoses and 12,000 deaths every year [1], and is a leading cause of cancer-related mortality among men. There is a long-documented history of racial disparities in prostate cancer outcomes, with Black men having up to twice the lifetime risk of dying from the disease compared with white men [2]. Addressing these inequalities in prostate cancer mortality is therefore a pressing public health priority. 

The causes of these racial disparities are widely recognised to be multifactorial, involving cancer biology, genetics, lifestyle and environmental exposures, differences in access to PSA testing, broader social circumstances, and systemic racism [3]. Among these, the social determinants of health play an important role in shaping prostate cancer outcomes. These refer to the wider circumstances of an individual’s life, including where they are born, live and work, as well as their access to essential resources such as healthcare and education [4]. 

Socioeconomic deprivation is a key social determinant of prostate cancer outcomes. Research has shown that men living in more deprived areas are more likely to be diagnosed with metastatic prostate cancer [5]. In England, Black men are disproportionately represented in more deprived neighbourhoods [6], raising the possibility that deprivation may be a major contributor to the higher mortality risk observed in this group. 

Despite this evidence, it remains unclear to what extent socioeconomic deprivation accounts for the observed ethnic disparities in prostate cancer mortality. To address this gap, the present report investigates the impact of area-based deprivation on prostate cancer mortality. The analysis draws on population-level data from the Office for National Statistics (ONS), covering all registered prostate cancer deaths in England between 21st March 2021 and 31st January 2023. 

Data and Methods 

This study is a population-based analysis of all registered prostate cancer deaths in England between 21st March 2021 and 31st January 2023 (registrations up to 17 April 2023) using data from the ONS [7]. Prostate cancer deaths were identified through the International Classification of Diseases, 10th Revision (ICD-10) code C61, recorded as either the underlying cause of death or as a contributing factor on the death certificate. 

The study population was comprised of usual England residents who responded to the 2021 Census and could be linked to the 2019 NHS Personal Demographics Service (PDS). As characteristics such as ethnicity and socioeconomic status (e.g. Index of Multiple Deprivation [IMD] and National Statistics Socio-economic Classification [NS-SEC]) are not routinely recorded on death certificates, these measures were derived through linkage with self-reported 2021 Census data and the NHS PDS, which provided up-to-date demographic, residential and occupational information. NS-SEC data only included individuals age 16 and over who were not in full time education. For those retired, NS-SEC was based on their most recent main job. Descriptive statistics were generated using Microsoft Excel and R. Age-standardised mortality rates (ASMRs) were calculated per 100,000 person-years by the ONS, which allowed comparability across groups with differing age structures, for example between the on average older Black Caribbean population and younger Black African population [8]. Rate ratios with corresponding 95% confidence intervals were also derived to quantify relative differences in mortality between groups. 

We conducted an exploratory analysis of the relationship between NS-SEC codes and prostate cancer mortality. However, due to limitations with this variable, we restricted our findings to deprivation and ethnicity, with the NS-SEC analysis presented in the supplementary material. 

Limitations

This analysis is based on ONS experimental statistics, meaning that the methodology remains under development and may be subject to future refinement [9].  

In addition, the dataset includes cases where prostate cancer was recorded anywhere on the death certificate, either as the underlying cause or as a contributory factor. While this approach captures a broader range of deaths, it may overestimate mortality attributable directly to the disease. 

Sample sizes for certain ethnic groups were relatively small, particularly for several Asian subgroups and the Black African group with counts suppressed by the ONS as presented in Table 1. Consequently, these groups were excluded from some analyses, which limits the ability to draw robust conclusions across all ethnic minority groups. 

Results

Description of Cohort/Dataset 

Between 21st March 2021 and 31st January 2023, there were 26,270 registered deaths from prostate cancer in England. Table 2 presents the distribution of deaths by ethnic group alongside their population proportions. The overall age-standardised mortality rate (ASMR) in England during this period was 71.3 per 100,000 person-years, reflecting the significant burden of the disease nationally. Mortality was strongly age-related, with men aged 70 years and above accounting for 89% of all prostate cancer deaths in the dataset. This concentration of deaths among older age groups is consistent with existing evidence that prostate cancer is a disease associated with older age [10] and highlights the importance of accounting for age when interpreting mortality trends across different demographic and socioeconomic groups.

How do prostate cancer mortality rates vary by ethnicity in England? 

Ethnicity is a well-established factor influencing prostate cancer outcomes, with previous studies reporting a higher absolute risk of prostate cancer mortality among Black men and lower absolute risk of prostate cancer mortality among Asian men compared with their white counterparts [2]. This analysis assessed whether these patterns persist in recent mortality data by comparing age-standardised mortality rates (ASMRs) across ethnic groups in England between March 2021 and January 2023. 

There are clear differences in prostate cancer mortality rates between ethnic groups consistent with previous research. Figure 1 presents ASMRs per 100,000 person-years by ethnicity. Mortality rates were highest among men from Black ethnic backgrounds, followed by white ethnic groups, and lowest in Asian groups. Compared to white British men, prostate cancer mortality rates were 1.73 times higher among Black Caribbean men (95% CI: 1.72 – 1.73) and 1.28 times higher among Black African men (95% CI: 1.26 – 1.30). In contrast, Asian groups experienced substantially lower mortality rates than white British men. For instance, Indian men had around 39% lower mortality than white British men (rate ratio: 0.61, 95% CI: 0.60–0.62). Given the limited sample size and broader confidence intervals for some of the ethnic subgroups included in our analysis, these findings need to be interpreted with caution. However, our analysis supports prior evidence of pronounced ethnic inequalities in prostate cancer mortality, suggesting that such disparities remain evident in recent years. 

Important differences were also observed within major ethnic groups. Among Black men, mortality rates were higher in the Black Caribbean group compared with the Black African group. Relative to Black African men, Black Caribbean men had 35% higher mortality (rate ratio: 1.35, 95% CI: 1.33–1.38). Within Asian groups, Indian men experienced substantially higher mortality, with rates more than twice those of Bangladeshi men (rate ratio: 2.24, 95% CI: 1.99–2.50). However, mortality rates for smaller subgroups such as Bangladeshi men should be interpreted with caution due to small sample sizes in these groups. These findings indicate that the burden of prostate cancer mortality may not be equally shared across broad ethnic groups. The differences observed between Black African and Black Caribbean men are aligned with previous data [11] and need to be further investigated. Grouping populations into broad categories may mask important within-group heterogeneity, with distinct subgroups facing differing levels of mortality risk, which is highly relevant to understanding and tackling health inequalities.  

Taken together, these results indicate notable differences in prostate cancer mortality, both between and within broad ethnic groups. Analysis of additional years of data could help increase the sample size and strengthen these findings.  

Do ethnic inequalities in prostate cancer mortality persist across different levels of deprivation? 

Deprivation has consistently been associated with poorer prostate cancer outcomes including higher mortality rates, partly due to later diagnosis and unequal access to healthcare [12]. The Index of Multiple Deprivation (IMD) is England’s official measure of area-based deprivation. It combines seven domains including income, employment, health and disability, education, barriers to housing and services, crime, and living environment, into a single measure of deprivation. Areas are then ranked and grouped into quintiles, from the most deprived to the least deprived [13]. This measure was used in the present analysis to investigate whether deprivation influences the ethnic disparities seen in prostate cancer mortality. For clarity, one subgroup was selected from each of the major ethnic categories (Black Caribbean, White British, Indian) to illustrate patterns across deprivation quintiles, due to suppressed data in several ethnic subcategories.

Across all ethnic groups analysed, a general trend of a deprivation gradient was observed, with mortality rates higher in the more deprived quintiles and lower in less deprived quintiles, as shown in Figure 2. The largest relative difference in mortality between the Black Caribbean and white British groups was seen in the most deprived quintile, where the Black population is known to be overrepresented6. In this quintile, Black Caribbean men were 1.76 times more likely to die than white British men (95% CI: 1.75–1.78). While in the next two most deprived quintiles Black Caribbean men were 1.66 and 1.48 times more likely to die than British men, respectively. This suggests that deprivation plays some role in shaping prostate cancer outcomes and contributes to some of the elevated mortality observed among Black men. However, although the relative difference narrowed slightly in less deprived quintiles, ethnic disparities still persisted at every level of deprivation, as illustrated by the ethnic gaps in mortality rates.  

Overall, Black Caribbean men experienced the highest mortality rates across all deprivation quintiles. This indicates that while deprivation may partly account for differences in prostate cancer mortality, it is unlikely to be the key explanation for the relatively high age-standardised mortality observed for Black men. Other factors, such as institutional racism, cultural differences, barriers within healthcare, and genetic susceptibility, may also play a major role [14]. 

In summary, while deprivation shapes overall levels of prostate cancer mortality, substantial ethnic differences persist, pointing to additional underlying drivers for this. 

Recommendations 

1. Address systemic inequalities in prostate cancer care  

This report highlights clear ethnic and socioeconomic inequalities in prostate cancer mortality in England. Black men, particularly Black Caribbean men, experience disproportionally higher mortality when compared to other ethnic groups.  Our analysis sheds light on important differences within broad ethnic categories, showing that mortality is not equally distributed even within the same major ethnic group.  

To tackle these inequalities, a key priority is to identify systemic inequities within the healthcare system that contribute to poorer outcomes for Black men and men living in areas of high deprivation. Policy changes to referral and treatment pathways are needed to ensure equitable access to care, while education and training for healthcare professionals should focus on the barriers Black men and men living in areas of deprivation face, including structural racism, to reduce clinical bias and promote culturally competent care. Alongside this, targeted awareness and early detection initiatives for high-risk groups, are essential to support earlier diagnosis and improve prostate cancer outcomes. 

Past evidence has shown that Black men with high-risk prostate cancer are less likely to receive radical treatment compared to White men15, suggesting barriers along the treatment pathway may contribute to the enduring disparities in prostate cancer outcomes. In addition, given how deprivation alone cannot fully account for the observed disparities, further qualitative and quantitative research is needed to disentangle the multiple factors behind disparity in treatment and outcomes. 

 

2. Improve data collection and representation  

Improving data collection and representation is crucial to ensure higher-quality evidence, particularly for UK ethnic minority groups who are often under-represented in healthcare datasets. UK healthcare datasets should adopt a consistent and comprehensive protocol for recording ethnicity data. It is also important that, where possible, ethnicity data collection goes beyond broad categories and captures more detailed subgroups, as these can experience markedly different risks and outcomes. 

At the national level, population datasets such as the Census must also strengthen the representation of ethnic minority groups, for example through proactive community engagement to promote understanding of how data is used and encourage provision of data by ethnic minorities in the UK so  that more effective health policies are implemented based on evidence which reflects the experiences of all men.  Consistency in the collection and reporting of ethnicity data is critical to identify and address inequities in healthcare.  There is discrepancy in how ethnicity data for ethnic minority subgroups are collected and recorded throughout the system. Standardising both the categorisation of ethnic subgroups and the practice of capturing self-identified ethnicity across all health services will improve data accuracy and support evidence-based decision-making. Greater availability of ethnicity data can enable further research to understand why there are differences in prostate cancer mortality and other outcomes between and within ethnic groups. 

Collectively, these measures are essential for generating the robust evidence needed to understand health inequalities in prostate cancer outcomes among ethnic groups and to inform policy development and guide targeted interventions to address them. 

Conclusion

This report confirms that Black men in England experience a higher burden of prostate cancer mortality compared to men of other ethnicities. Importantly, we found large variation in mortality rates within broad ethnic groups, with Black Caribbean men consistently experiencing the highest prostate cancer mortality rates.  

Analysis by area-based deprivation (IMD) demonstrated a clear gradient across all ethnicities, with mortality highest in the most deprived quintiles. Yet ethnic disparities persisted at every level, with Black Caribbean men consistently experiencing the greatest burden. Our findings indicate that the elevated prostate cancer mortality observed among Black men cannot be explained by socioeconomic factors alone. 

Joan Kolo, Abel Tesfai, Harris Wong, Marion Alaka and Natalia Norori.  

  1. Prostate Cancer UK. Data and Evidence Library for Health Improvement (DELHI) [Internet]. 2024. Available from: https://prostatecanceruk.org/for-health-professionals/data-and-evidence  

  1. Lloyd T, Hounsome L, Mehay A, Mee S, Verne J, Cooper A. Lifetime risk of being diagnosed with, or dying from, prostate cancer by major ethnic group in England 2008–2010. BMC Medicine. 2015 Jul 30;13(1). 

  1. Gulati R, Nyame YA, Lange J, Shoag J, Tsodikov A, Etzioni R. Racial disparities in prostate cancer mortality: a model-based decomposition of contributing factors. Journal of The National Cancer Institute Monographs. 2023 Nov 1;2023(62):212–8. 

  1. World Health Organization. Social Determinants of Health [Internet]. www.who.int. 2025. Available from: https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1  

  1. Dodkins J, Cook A, Mayne E, Parry M, Nossiter J, Payne H, et al. Geographic, socioeconomic and demographic inequalities in the incidence of metastatic prostate cancer at time of diagnosis in England: a population-based evaluation. BMJ Oncology. 2025 Apr;4(1):e000643.  

  1. Gov.uk. People Living in Deprived Neighbourhoods [Internet]. www.ethnicity-facts-figures.service.gov.uk. 2020. Available from: https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/people-living-in-deprived-neighbourhoods/latest/  

  1. Office for National Statistics. Inequalities in mortality involving common physical health conditions, England: 21 March 2021 to 31 January 2023 [Internet]. www.ons.gov.uk. 2023. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthinequalities/bulletins/inequalitiesinmortalityinvolvingcommonphysicalhealthconditionsengland/21march2021to31january2023 

  1. UK Government. Age groups [Internet]. www.ethnicity-facts-figures.service.gov.uk. 2023. Available from: https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/age-groups/latest/#black-ethnic-groups-age-profile  

  1. Office for National Statistics. Guide to experimental statistics [Internet]. www.ons.gov.uk. 2023. Available from https://www.ons.gov.uk/methodology/methodologytopicsandstatisticalconcepts/guidetoexperimentalstatistics  

  1. Stangelberger A, Matthias Waldert, Djavan B. Prostate Cancer in Elderly Men. Reviews in Urology. 2024;10(2):111–9. 

  1. Office for National Statistics. Mortality from leading causes of death by ethnic group, England and Wales [Internet]. www.ons.gov.uk. 2021. Available from  https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/datasets/mortalityfromleadingcausesofdeathbyethnicgroupenglandandwales 

  1. Padhani AR, Gianella A, Dodhia V, Moghul M, McCabe J, Ashdown C, et al. Transforming Prostate Cancer Management in the United Kingdom: A Roadmap for Optimisation of Patient Care Delivery. Trends in Urology & Men s Health. 2025 May 21;16(3).  

  1. Lloyd CD, Norman PD, McLennan D. Deprivation in England, 1971–2020. Applied Spatial Analysis and Policy. 2022 Nov 16;16(1):1–24. 

  1. National Voices. Advancing racial health equity – the Prostate Cancer UK experience [Internet]. www.nationalvoices.org.uk. 2025. Available from  
    https://www.nationalvoices.org.uk/blogpost/advancing-racial-health-equity-the-prostate-cancer-uk-experience 

  1. National Prostate Cancer Audit. State of the Nation Report 2024 [Internet]. www.natcan.org.uk. 2025. Available from: https://www.natcan.org.uk/reports/npca-state-of-the-nation-report-2024/  

Exploratory analysis: Are ethnic disparities in prostate cancer mortality greater in certain socioeconomic groups? 

Socioeconomic position is a key determinant of health and can be measured in different ways. While area-based measures such as the Index of Multiple Deprivation (IMD) capture neighbourhood disadvantage, individualised measures such as occupational class may reveal inequalities that are not apparent at the area level. Examining both allows a more comprehensive understanding of the drivers of health inequalities. The National Statistics Socio-economic Classification (NS-SEC) provides a more individualised measure of socioeconomic status, categorising individuals into occupational groups, ranging from higher managerial and professional roles to routine occupations and long-term unemployment [1]. It is frequently used in health inequalities research to assess the impact of occupational class on health outcomes. In the present exploratory analysis, NS-SEC was used to examine whether ethnic disparities in prostate cancer mortality varied across occupational classes. For clarity, due to limitations in the sample size, one subgroup was selected from each of the major ethnic categories (Black Caribbean, White British, Indian) to illustrate patterns across socioeconomic groups). 

Patterns of prostate cancer mortality by ethnicity and occupational class were less clear than those observed with area-based deprivation (Figure 3). Among white British men, a relatively steady gradient was observed, with mortality rates lowest in higher managerial and professional occupations but marginally increased in routine and unemployed groups. In contrast, mortality rates among Black Caribbean and Indian men showed greater fluctuation across occupational classes. These irregular patterns are likely due to smaller sample sizes within these subgroups, which reduces the robustness of the results and should therefore be interpreted with caution. 

Despite these fluctuations, Black Caribbean men consistently had the highest prostate cancer mortality rates across all occupational classes. Crucially, the presence of inequalities even among higher occupational groups highlights that socioeconomic factors alone cannot explain the elevated mortality risk among Black men. Consistent with the deprivation analysis, these results suggest that while socioeconomic position contributes to differences in prostate cancer mortality, other factors are likely to underpin the persistent inequalities faced by Black men. 

  1. Office for National Statistics. The National Statistics Socio-economic classification (NS-SEC) [Internet]. www.ons.gov.uk. n.d. Available from: https://www.ons.gov.uk/methodology/classificationsandstandards/otherclassifications/thenationalstatisticssocioeconomicclassificationnssecrebasedonsoc2010