Understanding the Racial and Ethnic Differences in Cost and Mortality Among Advanced Stage Prostate Cancer Patients (STROBE).
The aims of the study were to understand the racial/ethnic differences in cost of care and mortality in Medicare elderly with advanced stage prostate cancer.This retrospective, observational study used SEER-Medicare data. Cohort consisted of 10,509 men aged 66 or older and diagnosed with advanced-stage prostate cancer between 2001and 2004. The cohort was followed retrospectively up to 2009. Racial/ethnic variation in cost was analyzed using 2 part-models and quantile regression. Step-wise GLM log-link and Cox regression was used to study the association between race/ethnicity and cost and mortality. Propensity score approach was used to minimize selection bias.Pattern of cost and mortality varies between racial/ethnic groups. Compared with other racial/ethnic groups, non-Hispanic white patients had higher unadjusted costs in treatment and follow-up phases. Quintile regression results indicated that in treatment phase, Hispanics had higher costs in the 95th quantile and non-Hispanic blacks had lower cost in the 95th quantile, compared with non-Hispanic white men. In terminal phase non-Hispanic blacks and Hispanics had higher cost. After controlling for treatment, all-cause and prostate cancer-specific mortality was not significant for non-Hispanic black men, compared with non-Hispanic white men. However, for Asians, mortality remained significantly lower compared with non-Hispanic white men.In conclusion, relationship between race/ethnicity, cost of care, and mortality is intricate. For non-Hispanic black men, disparity in mortality can be attributed to treatment differences. To reduce racial/ethnic disparities in prostate cancer care and outcomes, tailored policies to address underuse, overuse, and misuse of treatment and health services are necessary.
From the Department of Psychiatry (SC); Division of Urology, Department of Surgery (SBM, RJ); Department of Medicine (JSS, RJ); and Leonard Davis Institute of Health Economics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania (JSS, RJ).
Sumedha
S
Chhatre
Stanley
S
Bruce Malkowicz
J
J
Sanford Schwartz
Ravishankar
R
Jayadevappa
D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005006:Ethnicity / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare; D009367:Neoplasm Staging; D057216:Propensity Score; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000191:economics* / Q000208:ethnology* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data