title: 'Race' and prostate cancer mortality in equal-access healthcare systems.
abstract: BACKGROUND
  Reports suggest worse health-related outcomes among black (vs white) men diagnosed with prostate cancer, but appropriate cause-effect inferences are complicated by the relationship of race and other prognostic factors.
  
  
  METHODS
  We searched the literature to find contemporary articles focusing on mortality among black and white men with prostate cancer in equal-access healthcare systems. We also directly assessed the association of race and prostate cancer mortality by conducting an observational cohort analysis of 1270 veterans diagnosed with prostate cancer and followed for 11 to 16 years at 9 medical centers within the Veterans Health Administration.
  
  
  RESULTS
  Among 5 reports providing quantitative results for the association of race and mortality among men with prostate cancer in equal-access systems, outcomes were similar for black and white men. Race also was not a prognostic factor in the observational cohort analysis of US veterans, with an adjusted hazard ratio for black (vs white) men and prostate cancer mortality of 0.90 (95% confidence interval, 0.58-1.40; P = .65).
  
  
  CONCLUSIONS
  Mortality among black and white patients with prostate cancer is similar in equal-access healthcare systems. Studies that find racial differences in mortality (including cause-specific mortality) among men with prostate cancer may not account fully for socioeconomic and clinical factors.
authors.affiliation: Clinical Epidemiology Research Center, Medical Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center, West Haven, Conn; Department of Medicine, Yale University School of Medicine, New Haven, Conn.
authors.forename: Tisheeka
authors.initials: T
authors.lastname: Graham-Steed
authors.forename: Edward
authors.initials: E
authors.lastname: Uchio
authors.forename: Carolyn K
authors.initials: CK
authors.lastname: Wells
authors.forename: Mihaela
authors.initials: M
authors.lastname: Aslan
authors.forename: John
authors.initials: J
authors.lastname: Ko
authors.forename: John
authors.initials: J
authors.lastname: Concato
mesh_terms: D001741:Black or African American; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D014481:United States; D044465:White People
keywords: Delivery of health care; Ethnic groups; Healthcare disparities; Prostatic neoplasms; Race