Prostate cancer mortality is twice as high in African American men compared with white men, a fact often attributed to poor education, lack of awareness of the threat, and undiscovered genetic factors.

In fact, according to a study published online March 12 in Cancer, screening, treatment choices, and health behavior are all affected by barriers that “arise directly from the racial disparity in socioeconomic position, not reduced information or culturally based misunderstandings sometimes presumed to arise in its wake.”

Dr. James A. Talcott of the Center for Outcomes Research at Harvard Medical School and colleagues surveyed 207 African American men and 348 white men from North Carolina who were recently diagnosed with prostate cancer. The disparities they found, generally attributed to lower social position, translate “into disadvantages in their medical care that may escape notice in studies that collect less detailed information than ours,” wrote the authors.

For example, the researchers found that African Americans were more aware than white men of their prostate cancer risk and the responsibility to get screened. Yet they were less able to access good medical care because of less convenient health care settings, less public and private insurance coverage, and less flexible work circumstances.

Distrust of their physicians was also rooted in African Americans’ health care experiences. Their lower income, educational level, and social status make them more likely to use public clinics and emergency rooms and less likely to receive continuity of care. They were also less likely to establish ongoing ties with a primary physician, had less frequent regular physical exams, and less follow-up on significant medical complaints. These findings led researchers to conclude that African Americans “are simply less likely to know their physicians and other providers well enough to develop trust.”