PD30-12 RACIAL DISPARITIES IN THE SURGICAL CARE OF LOCALIZED PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized II1 Apr 2015PD30-12 RACIAL DISPARITIES IN THE SURGICAL CARE OF LOCALIZED PROSTATE CANCER Marianne Schmid, Christian Meyer, Gally Reznor, Julian Hanske, Jesse Sammon, Firas Abdollah, Akshay Sood, Deepansh Dalela, Brandon Mahal, Adam Kibel, Felix Chun, Paul Nguyen, Mani Menon, Margit Fisch, and Quoc-Dien Trinh Marianne SchmidMarianne Schmid More articles by this author , Christian MeyerChristian Meyer More articles by this author , Gally ReznorGally Reznor More articles by this author , Julian HanskeJulian Hanske More articles by this author , Jesse SammonJesse Sammon More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Akshay SoodAkshay Sood More articles by this author , Deepansh DalelaDeepansh Dalela More articles by this author , Brandon MahalBrandon Mahal More articles by this author , Adam KibelAdam Kibel More articles by this author , Felix ChunFelix Chun More articles by this author , Paul NguyenPaul Nguyen More articles by this author , Mani MenonMani Menon More articles by this author , Margit FischMargit Fisch More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1833AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer (PCa) mortality is higher among African Americans (AA) than among non-Hispanic white men (NHWM). Understanding variations in quality of care is an important objective of research in racial disparities. We sought to evaluate racial variations in the use and outcomes of radical prostatectomy (RP) in patients with localized, non-metastatic PCa. METHODS The SEER-Medicare databases for the period from 1991 to 2009 were used to identify 26,482 AA and NHWM with localized PCa, who underwent RP within the first year of PCa diagnosis. We stratified patients according to ethnicity and compared process of care (i.e. time to treatment, lymph node dissection) as well as outcome measures (i.e. complications, emergency department visits, readmissions, PCa-specific mortality and all-cause mortality, costs). Cox proportional hazards regression, multivariable logistic regression and quantile regression were used to study racial disparities in outcomes and their association with process of care and outcome measures. RESULTS Compared to NHWM, AA were more likely to experience delayed treatment (59.4 vs. 69.5%, p<0.001); the top 50% wait 7 days longer for surgery (p<0.001). Furthermore, they were less likely to undergo lymph node dissection at surgery and were more likely to experience postoperative complications, transfusions, emergency department visits, readmissions and mortality (all p<0.05, Table). Surgical treatment of AA is associated with higher incremental annual cost (top 50% spend 1185.471$ more). However, compared with NHWM, AA did not experience worse PCa- specific mortality (Hazard ratio [HR]: 1.07, 95% confidence interval [CI]: 0.97-1.17, p=0.161) or all-cause mortality (HR: 1.07; 95% CI: 0.80- 1.42). CONCLUSIONS While AA experience worse quality of care for localized PCa (e.g. delayed treatment, postoperative complications) and higher treatment costs compared to NHWM, there were no difference in PCa-specific or all-cause mortality when treated with RP as definitive treatment. The current results indicate that surgical treatment for AA may mitigate the gap in survival classically reported between AA and NHWM afflicted with PCa. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e658-e659 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marianne Schmid More articles by this author Christian Meyer More articles by this author Gally Reznor More articles by this author Julian Hanske More articles by this author Jesse Sammon More articles by this author Firas Abdollah More articles by this author Akshay Sood More articles by this author Deepansh Dalela More articles by this author Brandon Mahal More articles by this author Adam Kibel More articles by this author Felix Chun More articles by this author Paul Nguyen More articles by this author Mani Menon More articles by this author Margit Fisch More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...