Improvement of racial disparities with respect to the utilization of minimally invasive radical prostatectomy in the United States

Abstract

BACKGROUND: Race represents an established barrier to health care access in the United States and elsewhere. We examined whether race affects the utilization rate of minimally invasive radical prostatectomy (MIRP) in a population‐based sample of individuals from the United States. METHODS: Within the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS), we focused on patients in whom MIRP and open radical prostatectomy (ORP) were performed between 2001 and 2007. We assessed the proportions and temporal trends in race distributions between MIRP and ORP. Multivariable logistic regression analyses further adjusted for age, year of surgery, baseline Charlson Comorbidity Index, annual hospital caseload tertiles, hospital region, insurance status, and median zip code income. RESULTS: Of 65,148 radical prostatectomies, 3581 (5.5%) were MIRPs. African Americans accounted for 11.4% of patients versus 78.8% for Caucasians versus 9.9% for others. Between 2001 and 2007, the annual proportions of Caucasian patients treated with MIRP were 2.2%, 0.9%, 2.6%, 7.2%, 4.7%, 9.3%, and 11.6%, respectively (chi‐square trend p<0.001). For the same years in African American patients, the proportions were 0.8, 0.3, 1.4, 4.4, 3.5, 9.0 and 8.4% (chi‐square trend P < .001). In multivariable analyses relative to Caucasian patients, African American patients were 14% less likely to undergo MIRP (P = .01). After period stratification between years 2001‐2005 versus 2006‐2007, African Americans were 22% less likely to undergo a MIRP in the early period (P = .007) versus 11% less likely to have a MIRP in the contemporary period (P = .1). CONCLUSIONS: The racial discrepancies in MIRP utilization rates are gradually improving. Cancer 2012;. © 2011 American Cancer Society.

National Trends and Disparities in the Use of Minimally Invasive Adult Pyeloplasty

“…To put this in perspective, consider that the usage rate of minimally invasive radical prostatectomy, now the predominant method of extirpative management of localized prostate cancer in the United States, showed a 5.3-fold and 10.5-fold increase in Caucasian and African-American patients, respectively, in a comparable study period (2001 to 2007). 24 Moreover it is noteworthy that robotic pyeloplasty is clearly driving this upsurge, accounting for 45.1% of all cases, with laparoscopic pyeloplasty accounting for just 10.2% of cases in 2009. Thus, among the various techniques of pyeloplasty offered, robotic pyeloplasty was the single most common method for operative correction of UPJO in 2009.…”

Racial Differences in the Surgical Care of Medicare Beneficiaries With Localized Prostate Cancer

“…38 Although access to these technologies might be improving, the data is adamant that Blacks are in fact still discriminated from such new technologies. 39 Therefore, it is unlikely that such phenomenon is responsible for the increased financial burden of RP in Blacks. A careful examination of the data would suggest that the more prevalent use of RT and ADT in Blacks may be partly responsible.…”

A Systematic Review of the Volume–Outcome Relationship for Radical Prostatectomy

“…Adding to the complexities of the volume–outcome debate in the context of RP is the large-scale diffusion of minimally invasive procedures (ie, laparoscopic, robot assisted) in recent years [65]. Current discussions on minimally invasive RPs predominantly revolve around its comparative effectiveness relative to the open approach, with respect to long-term outcomes.…”