Racial differences in health care utilization in Medicare beneficiaries with metastatic prostate cancer.

Abstract

31 Background: Racial differences in the prostate cancer (PC) incidence and outcomes have been previously reported. Patterns of PC care have been studied previously in commercially insured populations. This study evaluated racial differences in health care (HC) utilization in Medicare Beneficiaries with metastatic prostate cancer (MBMPC). Methods: MBMPCs were identified using Medicare 5% Standard Analytic Files (2002-2009) which included the Medicare fee-for-service population covered by Part A and Part B. HC costs were standardized to 2010 dollars. Patterns of care were analyzed and compared by race [White (W), Black (B), Other (O)]. Results: We identified 5,857 MBMPCs (W: 2,998, B: 748, O: 164) with a mean (SD) age 79.3 (9.4) years. Minimal differences in care were present between W and O. Compared to W, B received less outpatient care. Mean physician office visits/year: 21% fewer for all specialties (B: 10.4, W: 12.6, p<0.001), 20% fewer for primary care (B: 3.5, W: 4.2, p<0.001), 27% fewer for oncology (B: 2.2, W: 2.8, p<0.001), and no difference in urology (B: 1.9, W: 1.9, p=0.638). There was a 50% higher number of mean hospitalizations/yr in the B group (B: 1.2, W: 0.8, p<0.001). There was no difference in surgical intervention by race, however B were generally less likely to receive injection hormone therapy (HT), radiation therapy (RT), or chemotherapy (CT) prior to, concomitant to, or subsequent to the first metastatic diagnosis. Mean annual HC costs were 23% higher for B (B: $29,141, W: $23,735, p<0.001), with institutional care comprising 62% of total costs for B and 52% for W. Conclusions: In MBMPC, significant differences in HC between B and W were observed. B were less likely to experience physician office visits and to receive HT, RT, or CT, and more likely to be hospitalized. Further study is warranted to identify contributing factors and potential ways to reduce these observed HC disparities including patient education and patient engagement in decision-making.