Study reveals racial variation in quality of PCa surgery

September 6, 2012

African-American men with prostate cancer receive lower quality surgical care than Caucasian men, according to a study led by researchers from Vanderbilt-Ingram Cancer Center, Nashville, TN.

African-American men with prostate cancer receive lower quality surgical care than Caucasian men, according to a study led by researchers from Vanderbilt-Ingram Cancer Center, Nashville, TN.

The racial differences persist even when controlling for factors such as the year of surgery, age, comorbidities, and insurance status, according to the findings, which were published online in the Journal of Urology (Aug. 16, 2012).

The authors analyzed records of 105,972 prostate cancer patients who received radical prostatectomies in all nonfederal hospitals in Florida, Maryland, and New York from 1996 to 2007. Of the patients, 81,112 (76.5%) were Caucasian, 14,006 (13.2%) were African-American, 6,999 (6.6%) were Hispanic, and 3,855 (3.6%) represented all other races.

In the study, African-American men had 33% lower odds of using a high-volume surgeon and 27% lower odds of visiting a high-volume hospital than Caucasian men. Furthermore, African-American men had a higher rate of blood transfusion and longer length of stay in the hospital. They also were more likely to die in the hospital.

African-American men who used a high-volume hospital and high-volume surgeon were at substantially decreased risk for adverse outcomes, including death, than those using lower volume health care providers, but still had worse outcomes than their Caucasian counterparts.

The results suggest that African-American men may have more difficulty gaining access to high-quality care.

"Racial disparities in prostate cancer outcomes may be partially explained by differences in access to high-quality care, which in turn may reflect differences in patient resources," said first author Daniel Barocas, MD, MPH. "To close this gap, we may need interventions aimed at improving access to high quality care for all men, including access to high-volume health care providers."

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