title: Removal of the financial barrier to health care: does it impact on prostate cancer at presentation and survival? A comparative study between black and white men in a Veterans Affairs system.
abstract: OBJECTIVE
  African-American men are known to have a higher incidence and mortality rate from prostate cancer than American-Caucasian men. It is also known that African Americans have a higher incidence of advanced stage disease at diagnosis. One hypothesis for the latter is a delay in diagnosis due to lack of financial access to health care. Because eligibility for medical care in Veterans Affairs Medical Centers (VAMCs) is similar for both black and white patients, less disparity of stage at diagnosis, and therefore survival between blacks and whites, would be expected.
  
  
  METHODS
  Cases for this study included only those histologically confirmed, newly diagnosed prostate cancers at the Allen Park VAMC in Wayne County, Michigan, between 1973 and 1992. Trained Surveillance, Epidemiology, and End Result (SEER) abstractors determined the stage at diagnosis, according to SEER criteria. Data analyses include descriptive statistics and survival analysis.
  
  
  RESULTS
  The distribution of race and annual income of all male patients seen at the VAMC in Allen Park is similar. Over the entire 20-year period (1973 to 1992), there were a total of 358 prostate cancers in white patients and 383 in black patients. The ages of black and white patients were comparable. The proportion of white and black men presenting with localized disease is similar (57% and 54%, respectively). A significantly greater proportion of black patients with prostate cancer were classified as having distant disease compared with white patients (25% versus 19%; P = 0.045). A racial "crossover" effect in survival occurred around age 70 years, with white men demonstrating improved survival under 70 years of age, and black men 70 years and older tending to have better survival.
  
  
  CONCLUSIONS
  These data suggest that financial access to care has no apparent influence on the higher proportion of distant disease and poorer survival of African-American patients with prostate cancer compared with American-Caucasian men.
authors.affiliation: Department of Urology, Wayne State University, Detroit, Michigan, USA.
authors.forename: I J
authors.initials: IJ
authors.lastname: Powell
authors.forename: K
authors.initials: K
authors.lastname: Schwartz
authors.forename: M
authors.initials: M
authors.lastname: Hussain
mesh_terms: D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D006297:Health Services Accessibility / Q000191:economics*; D006787:Hospitals, Veterans; D006801:Humans; D007182:Income; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000191:economics / Q000208:ethnology* / Q000401:mortality; D012959:Socioeconomic Factors; D015996:Survival Rate; D044465:White People