title: Racial differences in treatment and outcomes among patients with early stage bladder cancer.
abstract: BACKGROUND
  Black patients are at greater of risk of death from bladder cancer than white patients. Potential explanations for this disparity include a more aggressive phenotype and delays in diagnosis resulting in higher stage disease. Alternatively, black patients may receive a lower quality of care, which may explain this difference.
  
  
  METHODS
  Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data for the years from 1992 through 2002, the authors identified patients with early stage bladder cancer. Multivariate models were fitted to measure relations between race and mortality, adjusting for differences in patients and treatment intensity. Next, shared-frailty proportional hazards models were fitted to evaluate whether the disparity was explained by differences in the quality of care provided.
  
  
  RESULTS
  Compared with white patients (n = 14,271), black patients (n = 342) were more likely to undergo restaging resection (12% vs 6.5%; P < .01) and urine cytologic evaluation (36.8% vs 29.7%; P < .01), yet they received fewer endoscopic evaluations (4 vs 5; P < .01). The use of aggressive therapies (cystectomy, systemic chemotherapy, radiation) was found to be similar among black patients and white patients (12% vs 10.2%, respectively; P = .31). Although black patients had a greater risk of death compared with white patients (hazards ratio [HR], 1.23; 95% confidence interval [95% CI], 1.07-1.42), this risk was attenuated only modestly after adjusting for differences in treatment intensity and provider effects (HR, 1.22; 95% CI, 1.06-1.42).
  
  
  CONCLUSIONS
  Although differences in initial treatment were evident, they did not appear to be systematic and had unclear clinical significance. Whereas black patients are at greater risk of death, this disparity did not appear to be caused by differences in the intensity or quality of care provided.
authors.affiliation: Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, MI48109-0330, USA. bhollen@umich.edu
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.forename: Zaojun
authors.initials: Z
authors.lastname: Ye
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.forename: Cheryl T
authors.initials: CT
authors.lastname: Lee
authors.forename: John D
authors.initials: JD
authors.lastname: Birkmeyer
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D018426:SEER Program; D014481:United States; D001749:Urinary Bladder Neoplasms / Q000208:ethnology* / Q000401:mortality / Q000628:therapy*; D044465:White People