Getting back to equal: The influence of insurance status on racial disparities in the treatment of African American men with high-risk prostate cancer.
OBJECTIVE
Treating high-risk prostate cancer (CaP) with definitive therapy improves survival. We evaluated whether having health insurance reduces racial disparities in the use of definitive therapy for high-risk CaP.


METHODS
The Surveillance, Epidemiology, and End Results Program was used to identify 70,006 men with localized high-risk CaP (prostate-specific antigen level > 20 ng/ml or Gleason score 8-10 or stage > cT3a) diagnosed from 2007 to 2010. We used multivariable logistic regression to analyze the 64,277 patients with complete data to determine the factors associated with receipt of definitive therapy.


RESULTS
Compared with white men, African American (AA) men were significantly less likely to receive definitive treatment (adjusted odds ratio [AOR] = 0.60; 95% CI: 0.56-0.64; P < 0.001) after adjusting for sociodemographics and known CaP prognostic factors. There was a significant interaction between race and insurance status (P interaction = 0.01) such that insurance coverage was associated with a reduction in racial disparity between AA and white patients regarding receipt of definitive therapy. Specifically, the AOR for definitive treatment for AA vs. white was 0.38 (95% CI: 0.27-0.54, P < 0.001) among uninsured men, whereas the AOR was 0.62 (95% CI: 0.57-0.66, P < 0.001) among insured men.


CONCLUSIONS
AA men with high-risk CaP were significantly less likely to receive potentially life-saving definitive treatment when compared with white men. Having health insurance was associated with a reduction in this racial treatment disparity, suggesting that expansion of health insurance coverage may help reduce racial disparities in the management of aggressive cancers.
Harvard Medical School, Boston, MA.
Brandon A
BA
Mahal
Harvard Medical School, Boston, MA.
David R
DR
Ziehr
Harvard Radiation Oncology Program, Boston, MA.
Ayal A
AA
Aizer
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Andrew S
AS
Hyatt
Vattikuti Center for Outcomes Research Analytics and Evaluation, Henry Ford Hospital, Detroit, MI.
Jesse D
JD
Sammon
Division of Urology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Marianne
M
Schmid
Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Toni K
TK
Choueiri
Department of Urology, UCLA Medical Center, Los Angeles, CA.
Jim C
JC
Hu
Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Christopher J
CJ
Sweeney
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Clair J
CJ
Beard
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Anthony V
AV
D'Amico
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Neil E
NE
Martin
Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Christopher
C
Lathan
Department of Urology, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, New Haven, CT.
Simon P
SP
Kim
Division of Urology, Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA.
Quoc-Dien
QD
Trinh
Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women׳s Hospital, Harvard Medical School, Boston, MA. Electronic address: pnguyen@LROCharvard.edu.
Paul L
PL
Nguyen
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act; D011471:Prostatic Neoplasms / Q000191:economics / Q000453:epidemiology / Q000208:ethnology* / Q000628:therapy*; D012307:Risk Factors; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
Affordable Care Act; African American; Cancer; Disparities; Insurance; Prostatic neoplasm