Race, Prostate Cancer Survival, and Membership in a Large Health Maintenance Organization

• Published in: JNCI : Journal of the National Cancer Institute 1998-07, Vol.90 (13), p.986-990
• Main Authors: Robbins, Anthony S., Whittemore, Alice S., Van Den Eeden, Stephen K.
• Format: Article
• Language: English
• Subjects: African Americans - statistics & numerical data; Aged; Analysis. Health state; Biological and medical sciences; Black people; Cause of Death; Epidemiology; European Continental Ancestry Group - statistics & numerical data; General aspects; Health Maintenance Organizations; HMOs; Humans; Male; Medical sciences; Men; Mortality; Neoplasm Staging; Nephrology. Urinary tract diseases; Prostate cancer; Prostatic Neoplasms - ethnology; Prostatic Neoplasms - mortality; Prostatic Neoplasms - pathology; Public health. Hygiene; Public health. Hygiene-occupational medicine; SEER Program; Survival Analysis; Tumors of the urinary system; United States - epidemiology; Urinary tract. Prostate gland; White people
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/90.13.986

Background: Population-based cancer registry data have shown that black men with prostate cancer have poorer stage-specific survival than white men, while studies in equal-access health care systems have not found racial differences in stage-specific survival. This study was designed to test the hypothesis that black men and white men with prostate cancer have equal stage-specific survival in equal-access health care systems. Methods: We conducted a cohort study using cancer registry data from all incident cases of prostate cancer occurring in a five-county San Francisco Bay Area region. Incident cases occurred among members (5263 cases, from January 1973 through June 1995) and nonmembers (16 019 cases, from January 1973 through December 1992) of the Kaiser Permanente Medical Care Program, a large health maintenance organization. Death rate ratios (DRRs, black men versus white men) for Kaiser members and nonmembers were computed for all stages combined (adjusting for age and stage) and for each stage (adjusting for age) Results: Among Kaiser members, adjusted DRRs comparing black men with white men were as follows: all stages combined, 1.28 (95% confidence interval [CI] = 1.14−1.44) local stage, 1.23 (95% CI = 1.01−1.51); regional stage, 1.30 (95% CI = 0.97−1.75); and distant stage, 1.27 (95% CI = 1.07−1.50). Corresponding DRRs for nonmembers were as follows: all stages combined, 1.22 (95% CI = 1.14 − 1.30); local stage, 1.24 (95% CI = 1.09−1.41); regional stage, 1.48 (95% CI = 1.29−1.68); and distant stage, 1.01 (95% CI = 0.91−1.12). Conclusions: These results show poorer prostate cancer survival for black men compared with white men in an equal-access medical care setting. The findings are most consistent with the hypothesis of increased tumor virulence in blacks. [J Nall Cancer Inst 1998;90:986–90]