MP04-05 THE IMPACT OF ACCESS-TO-CARE, PATIENT CHARACTERISTICS, AND DISEASE-SPECIFIC FACTORS ON PROSTATE CANCER MORTALITY

Abstract

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2016MP04-05 THE IMPACT OF ACCESS-TO-CARE, PATIENT CHARACTERISTICS, AND DISEASE-SPECIFIC FACTORS ON PROSTATE CANCER MORTALITY Erik N. Mayer, BS Heidi Hanson, andPhD, MS William T. LowranceMD, MPH Erik N. MayerErik N. Mayer More articles by this author , Heidi HansonHeidi Hanson More articles by this author , and William T. LowranceWilliam T. Lowrance More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1940AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous work examining the effect of access to care for patients with prostate cancer (CaP) has not examined the differential effects of access to care by individual level characteristics such as tumor stage, race/ethnicity, and age. We sought to examine how individual level factors interact with area level characteristics to affect prostate cancer mortality. METHODS Using the Surveillance, Epidemiology and End Results (SEER) database, we identified men 40 years of age or older who were diagnosed with malignant CaP between 2004 and 2012. The final cohort consisted of 510,429 men from 12 SEER registry areas. Records were linked to the Area Resource File 2006 (ARF) for county-level healthcare data. Cox regression models were used to test the association between individual and area-level characteristics and CaP mortality. RESULTS In contrast to previous studies, we found the main effect of metro designation, areas without chemotherapy programs, as well as the number of urologists, and radiation oncologists were not significant when controlling for individual level characteristics. Higher stage, increasing age, and black or Hispanic race/ethnicity were associated with higher CaP mortality. There is a strong association between median family income at the area level and CaP mortality, with 5% decrease in mortality per $10,000 increase in median family income (p<0.001). Counties with less than 130 physicians per 100k residents have a 7% increase in prostate cancer mortality compared to counties with more than 130 physicians per 100k residents (p=0.03). Black and Hispanic patients living in areas with less than 130 physicians or in areas with low median family income, or in counties with zero chemotherapy treatment centers had an increased risk of mortality compared to non-Hispanic whites. There were significant differences in the effect of living in a low SES area by age at diagnosis. The adverse effect associated with living in a low SES area was stronger for younger patients compared to patients aged 65 and older. CONCLUSIONS Decreased access to area level resources has a greater impact for at-risk populations. Increasing access to health care resources in these particularly vulnerable populations is necessary to reduce disparities in prostate cancer mortality. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e29 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Erik N. Mayer More articles by this author Heidi Hanson More articles by this author William T. Lowrance More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...