title: Differential adoption of laser prostatectomy for treatment of benign prostatic hyperplasia.
abstract: OBJECTIVE
  To evaluate whether socioeconomic environment affects the adoption of new laser technology for treatment of benign prostatic hyperplasia (BPH).
  
  
  METHODS
  Using all payer data, we identified all discharges for laser prostatectomy or transurethral resection of the prostate (TURP) performed in Florida (2001-2009). We determined whether or not each of 114 healthcare markets (Hospital Service Areas) offered laser prostatectomy or TURP and assessed the market-level socioeconomic environment using a previously described ZIP code-based summary score. We used generalized estimating equations to examine the association of socioeconomic environment with offering laser prostatectomy or TURP, adjusting for additional market characteristics.
  
  
  RESULTS
  Better socioeconomic environment was associated with offering laser prostatectomy (odds ratio 1.21 for each 1 point increase in summary score, 95% confidence interval 1.08-1.35, P <.001). Adoption of laser prostatectomy over time was more rapid in markets with superior socioeconomic environment (P <.001 for interaction of socioeconomic summary score with year), such that by study midpoint, 82% of advantaged vs 54% of disadvantaged markets had adopted this new technology. In contrast, socioeconomic environment had only minimal effects on whether or not a market offered TURP.
  
  
  CONCLUSIONS
  We found delayed access to new laser technology in more disadvantaged socioeconomic environments, which may translate into disparities in certain outcomes after transurethral surgery for BPH.
authors.affiliation: Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI 48109, USA.
authors.forename: Florian R
authors.initials: FR
authors.lastname: Schroeck
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Jacobs
authors.forename: Anne M
authors.initials: AM
authors.lastname: Suskind
authors.forename: Aruna V
authors.initials: AV
authors.lastname: Sarma
authors.forename: John T
authors.initials: JT
authors.lastname: Wei
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D005431:Florida; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D053685:Laser Therapy / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011468:Prostatectomy / Q000191:economics* / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000601:surgery*; D012959:Socioeconomic Factors; D020728:Transurethral Resection of Prostate / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States