title: Racial disparities in an aging population: the relationship between age and race in the management of African American men with high-risk prostate cancer.
abstract: OBJECTIVE
  To evaluate the relationship between age and race on the receipt of definitive therapy among men with high-risk prostate cancer (CaP).
  
  
  METHODS
  We used the Surveillance, Epidemiology and End Results Program to identify 62,644 men with high-risk CaP (PSA >20 or Gleason 8-10 or stage ≥cT3a) diagnosed from 2004 to 2010. Multivariable logistic regression analysis modeled the interaction between age and race and its association with receipt of definitive therapy on 57,674 patients (47,879 white men; 9,795 African American [AA] men) with complete data on the covariates of interest.
  
  
  RESULTS
  Among men age ≥70, AA men had a higher risk of CaP-specific mortality (PCSM) compared to white men after adjusting for sociodemographic and prostate cancer-specific factors (Adjusted HR 1.20; 95% CI 1.02-1.38; P=0.02). Nevertheless, a significant interaction between race and age was found (Pinteraction=0.01), such that the adjusted odds of receiving definitive treatment for AA vs. white was 0.67 (95% CI 0.62-0.73; P<0.001) among men age <70, but was 0.60 (95% CI 0.55-0.66; P<0.001) among men age ≥70, suggesting increased racial disparity in the receipt of definitive treatment among older men.
  
  
  CONCLUSIONS
  AA men with high-risk CaP are less likely to receive definitive therapy than white men. This disparity is significantly larger among men age ≥70, despite excess PCSM among AA men in this group. With a rapidly expanding population of older minority men, this disparity should be urgently addressed to prevent increasing disparities in cancer care.
authors.affiliation: Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Mahal
authors.affiliation: Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Ziehr
authors.affiliation: Harvard Radiation Oncology Program, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Ayal A
authors.initials: AA
authors.lastname: Aizer
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Hyatt
authors.affiliation: Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Lago-Hernandez
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Aymen A
authors.initials: AA
authors.lastname: Elfiky
authors.affiliation: Department of Urology, UCLA Medical Center, 757 Westwood Plaza, Los Angeles, CA 90095, USA.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sweeney
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Clair J
authors.initials: CJ
authors.lastname: Beard
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Department of Urology, Cancer Outcomes and Public Policy Effectiveness Research Center, Yale University, 20 York Street, North Pavilion 4, New Haven, CT 06510, USA.
authors.forename: Simon P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Lathan
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Electronic address: pnguyen@LROC.harvard.edu.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D054525:Minority Health / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000208:ethnology* / Q000628:therapy*; D012307:Risk Factors; D018426:SEER Program / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
keywords: African American; Geriatrics; Healthcare disparities; Population health; Prostatic neoplasms