title: Racial disparities in changing to a high-volume urologist among men with localized prostate cancer.
abstract: BACKGROUND
  Patients who receive surgery from high-volume surgeons tend to have better outcomes. Black patients, however, are less likely to receive surgery from high-volume surgeons.
  
  
  OBJECTIVE
  Among men with localized prostate cancer, we examined whether disparities in use of high-volume urologists resulted from racial differences in patients being diagnosed by high-volume urologists and/or changing to high-volume urologists for surgery.
  
  
  METHODS
  Retrospective cohort study from Surveillance, Epidemiology, and End Results-Medicare data.
  
  
  METHODS
  A total of 26,058 black and white men in Surveillance, Epidemiology, and End Results-Medicare diagnosed with localized prostate cancer from 1995 to 2005 that underwent prostatectomy. Patients were linked to their diagnosing urologist and a treating urologist (who performed the surgery).
  
  
  METHODS
  Diagnosis and receipt of prostatectomy by a high-volume urologist, and changing between diagnosing and treating urologist
  
  
  RESULTS
  After adjustment for confounders, black men were as likely as white men to be diagnosed by a high-volume urologist; however, they were significantly less likely than white men to be treated by a high-volume urologist [odds ratio 0.76; 95% confidence interval (CI), 0.67-0.87]. For men diagnosed by a low-volume urologist, 46.0% changed urologists for their surgery. Black men were significantly less likely to change to a high-volume urologist (relative risk ratio 0.61; 95% CI, 0.47-0.79). Racial differences appeared to reflect black and white patients being diagnosed by different urologists and having different rates of changing after being diagnosed by the same urologists.
  
  
  CONCLUSIONS
  Lower rates of changing to high-volume urologists for surgery among black men contribute to racial disparities in treatment by high-volume surgeons.
authors: Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD 21287, USA. cpollac2@jhmi.edu
authors: Craig Evan
authors: CE
authors: Pollack
authors: Justin E
authors: JE
authors: Bekelman
authors: Andrew J
authors: AJ
authors: Epstein
authors: Kaijun
authors: K
authors: Liao
authors: Yu-Ning
authors: YN
authors: Wong
authors: Katrina
authors: K
authors: Armstrong
mesh_terms: D000368:Aged; D044383:Black People / Q000706:statistics & numerical data; D016001:Confidence Intervals; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011468:Prostatectomy / Q000592:standards / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States; D014572:Urology / Q000592:standards / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American