title: Racial parity in tumor burden, treatment choice and survival outcomes in men with prostate cancer in the VA healthcare system.
abstract: BACKGROUND
  African-American men with prostate cancer typically have higher tumor risk at diagnosis, lower rates of surgical treatment and poorer cancer-specific survival compared with Caucasians. Receipt of care within the Veterans Affairs (VA) healthcare system may reduce barriers that influence these disparities.
  
  
  METHODS
  We sampled 1258 men with nonmetastatic prostate cancer diagnosed at the Greater Los Angeles and Long Beach VA Medical Centers between 1998 and 2004. We compared African Americans and Caucasians with respect to tumor characteristics using ordinal logistic regression, treatment choice across substrata of tumor risk using logistic regression, and cancer-specific and other-cause mortality using competing risks regression analysis.
  
  
  RESULTS
  Multivariate ordinal logistic regression revealed no significant differences in odds of higher tumor risk (odds ratio (OR) 1.22, 95% confidence interval (CI) 0.98-1.53, P=0.08), Gleason score (OR 0.90, 95% CI 0.7-1.16, P=0.4) or clinical stage (OR 1.04, 95% CI 0.79-1.38, P=0.8) for African Americans compared with Caucasians. African-American men had similar odds of aggressive treatment as did Caucasians for low-risk (OR 0.92, 95% CI 0.57-1.53, P=0.8), intermediate-risk (OR 0.75, 95% CI 0.44-1.26, P=0.3) and high-risk disease (OR 0.87, 95% CI 0.52-1.44, P=0.6). In competing risks regression analysis, African Americans had a lower but nonsignificant hazard of cancer-specific mortality compared with Caucasians (sub-hazard ratio 0.6, 95% CI 0.28-1.26, P=0.2) and nearly identical risk of other-cause mortality (sub-hazard ratio 0.98, 95% CI 0.78-1.22, P=0.8).
  
  
  CONCLUSIONS
  We found no significant differences in tumor burden, treatment choice or survival outcomes between African Americans and Caucasians cared for in the equal-access VA Healthcare setting.
authors.affiliation: 1] Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA [2] Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Daskivich
authors.affiliation: Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Kwan
authors.affiliation: Department of Urology, University of Washington, Seattle, Washington, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dash
authors.affiliation: 1] Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA [2] Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA [3] Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA [4] Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D001741:Black or African American; D000368:Aged; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology; D018426:SEER Program; D047368:Tumor Burden; D044465:White People