Racial Differences in the Surgical Care of Medicare Beneficiaries With Localized Prostate Cancer.
OBJECTIVE
There is extensive evidence suggesting that black men with localized prostate cancer (PCa) have worse cancer-specific mortality compared with their non-Hispanic white counterparts.


OBJECTIVE
To evaluate racial disparities in the use, quality of care, and outcomes of radical prostatectomy (RP) in elderly men (≥ 65 years) with nonmetastatic PCa.


METHODS
This retrospective analysis of outcomes stratified according to race (black vs non-Hispanic white) included 2020 elderly black patients (7.6%) and 24,462 elderly non-Hispanic white patients (92.4%) with localized PCa who underwent RP within the first year of PCa diagnosis in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database between 1992 and 2009. The study was performed in 2014.


METHODS
Process of care (ie, time to treatment, lymph node dissection), as well as outcome measures (ie, complications, emergency department visits, readmissions, PCa-specific and all-cause mortality, costs) were evaluated using Cox proportional hazards regression. Multivariable conditional logistic regression and quantile regression were used to study the association of racial disparities with process of care and outcome measures.


RESULTS
The proportion of black patients with localized prostate cancer who underwent RP within 90 days was 59.4% vs 69.5% of non-Hispanic white patients (P <  001). In quantile regression of the top 50% of patients, blacks had a 7-day treatment delay compared with non-Hispanic whites. (P <  001). Black patients were less likely to undergo lymph node dissection (odds ratio [OR], 0.76 [95% CI, 0.66-0.80]; P < .001) but had higher odds of postoperative visits to the emergency department (within 30 days: OR, 1.48 [95% CI, 1.18-1.86]); after 30 days or more (OR, 1.45 [95% CI, 1.19-1.76]) and readmissions (within 30 days: OR, 1.28 [95% CI, 1.02-1.61]); ≥ 30 days (OR, 1.27 [95% CI, 1.07-1.51]) compared with non-Hispanic whites. The surgical treatment of black patients was associated with a higher incremental annual cost (the top 50% of blacks spent $1185.50 (95% CI , $804.85-1 $1566.10; P < .001) more than the top 50% of non-Hispanic whites). There was no difference in PCa-specific mortality (P = .16) or all-cause mortality (P = .64) between black and non-Hispanic white men.


CONCLUSIONS
Blacks treated with RP for localized PCa are more likely to experience adverse events and incur higher costs compared with non-Hispanic white men; however, this does not translate into a difference in PCa-specific or all-cause mortality.
Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts2Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Marianne
M
Schmid
Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts2Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Christian P
CP
Meyer
Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Gally
G
Reznor
Dana-Farber Cancer Institute, Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Toni K
TK
Choueiri
Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Julian
J
Hanske
Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.
Jesse D
JD
Sammon
Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.
Firas
F
Abdollah
Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Felix K H
FK
Chun
Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Adam S
AS
Kibel
Center for Community-Based Research, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Reginald D
RD
Tucker-Seeley
Dana-Farber Cancer Institute, Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Philip W
PW
Kantoff
Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Stuart R
SR
Lipsitz
Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan.
Mani
M
Menon
Dana-Farber Cancer Institute, Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Paul L
PL
Nguyen
Center for Surgery and Public Health, Division of Urologic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Quoc-Dien
QD
Trinh
D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017048:Health Care Costs; D054625:Healthcare Disparities / Q000191:economics / Q000208:ethnology*; D006801:Humans; D007342:Insurance Benefits; D016015:Logistic Models; D008197:Lymph Node Excision; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D017064:Process Assessment, Health Care / Q000191:economics; D016016:Proportional Hazards Models; D011468:Prostatectomy / Q000009:adverse effects / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000191:economics / Q000208:ethnology / Q000401:mortality / Q000601:surgery*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People