title: Disparities associated with advanced prostate cancer stage at diagnosis.
abstract: This study expands on a previous report (focusing on health insurance status and race/ethnicity) to present effects of age, socioeconomic status, hospital type, and other factors (e.g., type of Medicaid and Medicare coverage, insurance-by-race/ethnicity interactions) on advanced-stage (III/IV) at prostate cancer diagnosis. Invasive (Stages I-IV) prostate cancer cases diagnosed during 1998-2004 were extracted from the National Cancer Database (N=687,464). Independent of health-insurance and race/ethnicity, socioeconomic status was a significant predictor of advanced stage at diagnosis, with patients residing in areas with lower socioeconomic characteristics having significantly increased odds. Those treated at community-cancer-centers had significantly decreased odds (versus teaching/research-facilities). Significantly increased odds were also observed among uninsured-Blacks, Medicare-insured-Blacks, Medicaid-insured-Blacks, Medicare-insured-Hispanics, and Medicare-insured-other-racial/ethnic-minorities 65 years old and older (versus corresponding White-populations). The impact of prostate cancer screening on reducing mortality remains debatable. Still, our results suggest improvements in multiple factors that affect access-to-care may achieve earlier diagnosis and, therefore, a potentially more treatable disease.
authors.affiliation: of Biostatistics and Epidemiology at the Medical University of South Carolina, SC 29425, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Marlow
authors.forename: Michael T
authors.initials: MT
authors.lastname: Halpern
authors.forename: Alexandre L
authors.initials: AL
authors.lastname: Pavluck
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Ward
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D006268:Health Facilities / Q000145:classification; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000473:pathology; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult; D001741:Black or African American