Racial inequities in the quality of surgical care among Medicare beneficiaries with localized prostate cancer

• Published in: Cancer 2023-05, Vol.129 (9), p.1402-1410
• Main Authors: Nyame, Yaw A., Holt, Sarah K., Etzioni, Ruth D., Gore, John L.
• Format: Article
• Language: English
• Subjects: Aged; Antigens; Black; Black or African American; Black people; Cancer surgery; Comorbidity; Death; Diagnosis; disparities; Epidemiology; Government programs; Health risks; Healthcare Disparities; Humans; Male; Medicare; Mortality; Oncology; Prostate cancer; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - surgery; quality of care; Race; Races; Risk analysis; Socioeconomics; Statistical analysis; Surgeons; United States - epidemiology; Urological surgery; White
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.34681

Background US Black men are twice as likely to die from prostate cancer as men of other races. Lower quality care may contribute to this higher death rate. Methods Sociodemographic and clinical data were obtained for men in Surveillance, Epidemiology, and End Results‐Medicare diagnosed with clinically localized prostate cancer (cT1‐4N0/xM0/x) and managed primarily by radical prostatectomy (2005–2015). Surgical volume was determined for facility and surgeon. Relationships between race, surgeon and/or facility volume, and characteristics of treating facility with survival (all‐cause and cancer‐specific) were assessed using multivariable Cox regression and competing risk analysis. Results Black men represented 6.7% (n = 2123) of 31,478 cohort. They were younger at diagnosis, had longer time from diagnosis to surgery, lower socioeconomic status, higher prostate‐specific antigen (PSA), and higher comorbid status compared with men of other races (p