You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making I (PD03)1 Sep 2021PD03-05 THE ROLE OF UROLOGY PRACTICE ORGANIZATION AND RACIAL COMPOSITION ON PROSTATE CANCER TREATMENT DISPARITIES Nnenaya A. Mmonu, Yongmei Qin, Samuel Kaufman, Mary Oerline, Christina Chapman, Brent K. Hollenbeck, and Ted A. Skolarus Nnenaya A. MmonuNnenaya A. Mmonu More articles by this author , Yongmei QinYongmei Qin More articles by this author , Samuel KaufmanSamuel Kaufman More articles by this author , Mary OerlineMary Oerline More articles by this author , Christina ChapmanChristina Chapman More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck More articles by this author , and Ted A. SkolarusTed A. Skolarus More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001967.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Though Black men have a higher risk of prostate cancer diagnosis and mortality, they are less likely to receive definitive treatment. Understanding the extent to which urology practice organization and racial composition might be associated with treatment patterns may lead to actionable insights to address disparities. METHODS: We identified Medicare beneficiaries diagnosed with prostate cancer between January 2010 and December 2015, and followed them through 2016. We identified a primary urologist for each patient; urologists were assigned to practices based on their Tax Identification Number (TIN). Each patient was assigned a unique TIN based on their primary urologist. We grouped TINs into quartiles based on the proportion of Black patients in a urology practice, with increasing quartile number (1-4) representing increasing proportion of Black patients (0-100%). We used multivariable regression to identify treatment associations. RESULTS: We identified 54,443 patients with incident prostate cancer assigned to 4,194 practices. The majority of patients were White (87%) with 9% Black. We found wide variation in racial practice composition (Figure). Some practices were comprised of no Black patients, while others were comprised of nearly all Black patients. The highest quartile comprised 955 practices with an average of 20% Black patients. This quartile had the greatest degree of low socioeconomic status (43.1%), higher comorbidity, and the youngest age of incident prostate cancer (all p<0.01). Black patients had lower odds of definitive therapy (adjusted odds ratio (aOR)=0.87, 95% confidence interval (CI): 0.81, 0.93). Patients with medium or high socioeconomic status also had higher odds of treatment (medium vs. low, aOR 1.09, 95% CI 1.04, 1.15; high vs. low, aOR 1.06, 95% CI 1.00, 1.12). Black patients underwent less surgery, more radiation, and cryotherapy than White patients. CONCLUSIONS: Though Black patients have higher diagnosis and mortality from prostate cancer, we found lower treatment rates despite Medicare insurance coverage. The associations of racial practice composition with treatment patterns and patient characteristics are reflective of the adverse effects of structural racism on prostate cancer disparities, and highlight the need for multilevel interventions to mitigate implications. Source of Funding: NIH © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e45-e46 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nnenaya A. Mmonu More articles by this author Yongmei Qin More articles by this author Samuel Kaufman More articles by this author Mary Oerline More articles by this author Christina Chapman More articles by this author Brent K. Hollenbeck More articles by this author Ted A. Skolarus More articles by this author Expand All Advertisement Loading ...
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