Racial disparities in mortality for patients with prostate cancer after radical prostatectomy

Abstract

Background Although racial disparities in prostate cancer survival are well documented, the relative importance of contributing factors remains unclear. Few studies have examined the disparity between Whites and Hispanics or between Whites and Asian Americans and Pacific Islanders (AAPIs). Methods Using data from the National Cancer Database for 526,690 patients with prostate cancer who underwent radical prostatectomy between 2004 and 2014, this study systematically evaluated the impact of clinical characteristics and factors related to access to care on survival by race. Included in the analysis were 432,640 White patients (82.1%), 63,602 Black patients (12.1%), 8990 AAPI patients (1.7%), and 21,458 Hispanic patients (4.1%). Multivariable Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals to measure racial survival disparities. Inverse probability weighting was used to adjust for imbalances of prognostic factors. Results When adjustments were made for age and year of diagnosis only, Blacks had 51% higher mortality, AAPIs had 22% lower mortality, and Hispanics had 6% lower mortality than Whites. Overall, with adjustments for all clinical factors and nonclinical factors, the Black‐White survival disparity narrowed to 20%, whereas the AAPI‐White disparity increased to 35%. Among the controlled‐for factors, education, median household income, and insurance status contributed the most to the racial disparity. Conclusions The overall survival disparity among men undergoing radical prostatectomy was significantly decreased, but not eliminated, for Blacks and significantly increased for AAPIs in comparison with Whites after adjustments for a number of clinical factors and factors related to access to care.

Racial Differences in Incident Genitourinary Cancer Cases Captured in the National Cancer Database

“…Our novel finding of a significantly higher case coverage rate for White versus Black Americans with genitourinary cancers is noteworthy in view of the well-described inferior treatment and survival outcomes among Black patients with these malignancies [ 6 , 12 , 13 , 14 , 15 ]. Interestingly, evidence demonstrating the presence and impact of racial disparities in prostate cancer and kidney cancer is particularly robust [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ], and it is these two malignancies which appear to be underlying the significantly higher overall genitourinary case capture rate in White versus Black subjects observed in the present analysis. Although disparities in urologic oncology are multifactorial and complex, differential access to cancer care undoubtedly plays a role in this phenomenon, and research derived from an equal-access healthcare system suggests that improved access to care may be key in mitigating racial disparities in genitourinary cancer outcomes [ 23 ].…”

Racial Differences in Prostate Cancer Characteristics and Cancer-Specific Mortality: An Overview

“…Recently, Wen et al [ 43 ] evaluated the impact of clinical characteristics and factors related to access to care on survival by race using data from the NCDB for 526,690 patients with prostate cancer who underwent radical prostatectomy. In their study, when adjustments were made for age and year of diagnosis only, it was observed that the Black, AAPIs (Asian Americans and Pacific Islanders), and Hispanic population had 51% higher mortality, 22% lower mortality, and 6% lower mortality, respectively compared to the Caucasian population.…”

Prostate cancer and the social construct of race

“…Studying men presenting at a large number of US hospitals in the US National Cancer Database, Wen et al 3 assessed the effectiveness of prostate cancer treatment, primarily radical prostatectomy, in the United States. They found that Black men with high‐grade, localized disease treated with radical prostatectomy had a 51% higher mortality rate (hazard ratio [HR], 1.51; 95% confidence interval, 1.47‐1.56).…”

“…Wen et al's study 3 is one of the few that have assessed outcomes among Asian American/Pacific Islander (AAPI) and Hispanic patients. It leaves us asking why AAPI and Hispanic patients as a group have better outcomes than Whites.…”