title: Impact of distance to a urologist on early diagnosis of prostate cancer among black and white patients.
abstract: OBJECTIVE
  We examined whether an increased distance to a urologist is associated with a delayed diagnosis of prostate cancer among black and white patients, as manifested by higher risk disease at diagnosis.
  
  
  METHODS
  North Carolina Central Cancer Registry data were linked to Medicare claims for patients with incident prostate cancer diagnosed in 2004 to 2005. Straight-line distances were calculated from the patient home to the nearest urologist. Race stratified multivariate ordinal logistic regression was used to examine the association between distance to a urologist and prostate cancer risk group (low, intermediate, high or very high/metastasis) at diagnosis for black and white patients while accounting for age, comorbidity, marital status and diagnosis year. An overall model was then used to examine the distance × race interaction effect.
  
  
  RESULTS
  Included in analysis were 1,720 white and 531 black men. In the overall cohort the high risk cancer rate increased monotonically with distance to a urologist, including 40% for 0 to 10, 45% for 11 to 20 and 57% for greater than 20 miles. Correspondingly the low risk cancer rate decreased with longer distance. On race stratified multivariate analysis longer distance was associated with higher risk prostate cancer for white and black patients (p = 0.04 and <0.01, respectively) but the effect was larger in the latter group. The distance × race interaction term was significant in the overall model (p = 0.03).
  
  
  CONCLUSIONS
  Longer distance to a urologist may disproportionally impact black patients. Decreasing modifiable barriers to health care access, such as distance to care, may decrease racial disparities in prostate cancer.
authors.affiliation: Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Holmes
authors.forename: William R
authors.initials: WR
authors.lastname: Carpenter
authors.forename: Yang
authors.initials: Y
authors.lastname: Wu
authors.forename: Laura H
authors.initials: LH
authors.lastname: Hendrix
authors.forename: Sharon
authors.initials: S
authors.lastname: Peacock
authors.forename: Mark
authors.initials: M
authors.lastname: Massing
authors.forename: Anna P
authors.initials: AP
authors.lastname: Schenck
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Meyer
authors.forename: Kevin
authors.initials: K
authors.lastname: Diao
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Wheeler
authors.forename: Paul A
authors.initials: PA
authors.lastname: Godley
authors.forename: Karyn B
authors.initials: KB
authors.lastname: Stitzenberg
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Chen
mesh_terms: D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D042241:Early Diagnosis; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D009657:North Carolina; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D012042:Registries; D012306:Risk; D014195:Travel; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American