Multiple factors may contribute to care inequity

March 1, 2018

"As much as racial and ethnic disparities exist broadly across health care in the United States, it is not surprising to observe this phenomenon in the urologic arena," writes Arthur L. Burnett, II, MD, MBA.

Arthur L. Burnett, II, MD, MBADr. Burnett,

 

In this issue of Urology Times, McAbee and colleagues provide an intriguing report about another possible racial disparity in health care management-that of African-American men receiving unequal surgical correction of stress urinary incontinence relative to white male counterparts. (See article Racial disparity seen with SUI surgical restoration.)

The findings here indicate not only a relative lesser extent of surgical restoration for stress urinary incontinence in African-American men, but interestingly enough, a higher extent of surgical correction of erectile dysfunction in this patient population. The data seem to suggest proportions of urologic prosthetic types among African-American men, although it is not clear what rate of urologic prosthetic surgery was performed among all men in this population who were eligible and may have benefited from these procedures.

An immediate conclusion might well be that African-American men uniquely seek to manage urinary incontinence less definitively than erectile dysfunction, as if the latter urologic complication is more impactful in this patient population. However, one should not so quickly leap to conclusions. In point of fact, numerous contributing factors for this outcome may be in play, including disease-related, patient-related, and provider/system-related factors.

Also by Dr. Burnett - URS and ED risk: Intriguing association

Quite possibly, African-American men may have earlier presented with more aggressive or advanced preceding urologic conditions whereby intensive treatments afforded higher complication rates, an often-described reality in the African-American community. Various socioeconomic, biologic, and even behavioral factors are relevant for this consideration. Possibly, African-American men have unease with certain surgical interventions, electing here not to pursue surgical correction for urinary incontinence, which would be in line with historical misdeeds in health care stoking distrust.

The outcomes of this study may additionally reflect geographic clinical practice differences related to the authors’ institution, such that they may not be generalizable.

As much as racial and ethnic disparities exist broadly across health care in the United States, it is not surprising to observe this phenomenon in the urologic arena. Ongoing outcome studies in our field should importantly examine the possibility of urologic health care inequity and identify its contributing factors. This charge conceivably would bring actionable steps to bear that would reduce or eliminate racial disparities in urologic health care.

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