Pd03-02 racial Disparities in Prostate Cancer Treatment in a Multi-Institutional Regional Collaborative

Abstract

INTRODUCTION AND OBJECTIVE: Symptomatic urinary stone disease is a common cause for emergency department (ED) visits; for some patients, ED revisits often occur before cessation of a stone episode. Little is known regarding how non-clinical factors such as patient race, ethnicity, or insurance status contribute to ED revisit for stone disease. We sought to identify associations between ED revisit and patient race/ethnicity.METHODS: This was a retrospective cohort study of patients in Florida, Georgia, and Maryland who had initial ED treat-and-release visits for urinary stone disease utilizing the state-specific Healthcare Cost and Utilization Project (HCUP) databases between 2016-2017. A repeat ED visit for urinary stones within 30 days of an initial ED encounter was the primary outcome. A generalized estimating equation with a logit link that accounted for hospital-level clustering was employed, using race/ethnicity as the primary predictor and adjusting for other covariates such as age, sex, and primary payer. Race and ethnicity were reported as a single variable by HCUP, with ethnicity taking precedence over race in the assignment; categories were White, Hispanic, Black, and Other/Unknown. RESULTS: Of the 209,309 patients who had an initial treat-andrelease ED visit for symptomatic urinary stones, 14,853 (7.1%) had at least one additional ED encounter for symptomatic stones within 30 days of their initial ED visit. Revisit percentages differed among racial/ ethnic groups (White 7.5%, Hispanic 6.8%, Black 5.7%, p < 0.001). Black (adjusted odds ratio (aOR) 0.72, 95% confidence interval (CI) 0.67 to 0.76) and Hispanic (aOR 0.88, 95% CI 0.82 to 0.94) individuals were less likely to revisit than White individuals. Primary insurance coverage with Medicaid compared to private insurance (aOR 1.49, 95% CI 1.41 to 1.57), and rural residence compared to large metropolitan (aOR 1.13, 95% CI 1.02 to 1.25) were associated with increased odds of revisit.CONCLUSIONS: In this cohort, repeat emergency care for symptomatic urinary stones affects 7.1% of patients after initial stone management in the ED setting. Race/ethnicity was associated with stone-related ED revisit. To understand the revisit discrepancies, further investigation into potential explanations of observed race/ethnicityassociated care patterns following initial ED encounters for urinary stones is warranted.

Cancer statistics for African American/Black People 2022

“…[131][132][133][134] For example, a multi-institutional study of the impact of the COVID-19 pandemic on prostate cancer treatment found that Black men experienced a 94% drop in surgery compared with no disruption in White men. 135 Despite fairly strong evidence that Black men have equivalent or higher prostate cancer-specific survival within an equal-access health care system such as the Veterans Health Administration, 52,136,137 a recent Veterans Health Administration study found that, among patients who were most likely to benefit from definitive treatment, Black men were 11% less likely than non-Black men to receive it. 138 Although there is some evidence that aggressive prostate cancer is more common in Black men, 131,139 these findings may be confounded by differences in access to high-quality treatment.…”

“…The larger disparity in prostate cancer mortality compared with incidence likely reflects less access to high‐quality treatment, which continues to be documented in Black men 131‐134 . For example, a multi‐institutional study of the impact of the COVID‐19 pandemic on prostate cancer treatment found that Black men experienced a 94% drop in surgery compared with no disruption in White men 135 . Despite fairly strong evidence that Black men have equivalent or higher prostate cancer‐specific survival within an equal‐access health care system such as the Veterans Health Administration, 52,136,137 a recent Veterans Health Administration study found that, among patients who were most likely to benefit from definitive treatment, Black men were 11% less likely than non‐Black men to receive it 138 .…”

Metastatic Prostate Adenocarcinoma Presenting as Acute Quadriplegia: A Case Report and Racial Disparity Analysis

“…A later stage makes prostate cancer more difficult to treat and is associated with an increased risk of relapse. At the start of the COVID-19 pandemic, there had also been a shift in cancer resource allocation which consequently made it less likely for black men to receive prostatectomy [ 21 ]. Furthermore, they are less likely to have health insurance, access to high-quality care, and more likely to have a lower socioeconomic status [ 19 ].…”