Association between ethnicity and prostate cancer outcomes across hospital and surgeon volume groups.
OBJECTIVE
We analyzed the association between ethnicity and outcomes among prostate cancer patients across hospital and surgeon volume groups.


METHODS
In this retrospective cohort study using SEER-Medicare databases for the period between 1995 and 2003, prostate cancer cases were identified and retrospectively followed for one year pre- and up to eight years post-diagnosis. Based on volume, hospitals and surgeons were divided into three groups each. For each group, we fitted separate models to analyze the association between ethnicity and outcomes such as complications, eight-year mortality and cost, adjusting for covariates. Poisson (zero inflation), generalized linear model (log-link), and Cox regression models were used.


RESULTS
African American ethnicity was associated with 30-day complications among medium volume hospital group. African American patients receiving care at medium volume hospitals and from medium volume surgeons had higher costs. Hispanic patients receiving care at low and medium volume hospitals had lower cost compared to white patients. Hispanic patients receiving care from a high-volume surgeon experienced increased hazard of long-term mortality.


CONCLUSIONS
Association between ethnicity and outcomes varies across hospital and surgeon volume groups. Thus, volume based policy measures may need further exploration for understanding the interaction between structure, process, volume and outcomes.
Jayadevappa
Ravishankar
R
Department of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA. jravi@mail.med.upenn.edu
Chhatre
Sumedha
S
Johnson
Jerry C
JC
Malkowicz
Stanley Bruce
SB
D000368:Aged; D017598:Efficiency, Organizational; D005006:Ethnicity / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D008297:Male; D016134:Organizational Policy; D017063:Outcome Assessment, Health Care; D010820:Physicians / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000601:surgery*; D012189:Retrospective Studies; D018426:SEER Program; D016526:Workload