Racial disparities in urologist visits among elderly men with prostate cancer: A cohort analysis of patient‐related and county of residence‐related factors

Abstract

BACKGROUND: Factors contributing to the lower likelihood of urologist follow-up among African American (AA) men diagnosed with prostate cancer may not be strictly related to patient factors. The authors investigated the relationship between crime, poverty, and poor housing, among others, and postdiagnosis urologist visits among AA and white men. METHODS: The authors used linked cancer registry and Medicare claims data from 1999 through 2007 for men diagnosed with American Joint Committee on Cancer stage I to III prostate cancer. The USA Counties and County Business Patterns data sets provided county-level data. Variance components models reported the percentage of variation attributed to county of residence. Postdiagnosis urologist visits for AA and white men were investigated using logistic and modified Poisson regression models. RESULTS: A total of 65,635 patients were identified; 87% of whom were non-Hispanic white and 9.3% of whom were non-Hispanic AA. Approximately 16% of men diagnosed with stage I to III prostate cancer did not visit a urologist within 1 year after diagnosis (22% of AA men and 15% of white men). County of residence accounted for 10% of the variation in the visit outcome (13% for AA men and 10% for white men). AA men were more likely to live in counties ranked highest in terms of poverty, occupied housing units with no telephone, and crime. AA men were less likely to see a urologist (odds ratio, 0.65 [95% confidence interval, 0.6-0.71]; rate ratio, 0.94 [95% confidence interval, 0.92-0.95]). The sign and magnitude of the coefficients for the county-level measures differed across race-specific regression models of urologist visits. CONCLUSIONS: Among older men diagnosed with stage I to III prostate cancer, the social environment appears to contribute to some of the disparities in postdiagnosis urologist visits between AA and white men. Cancer 2014;120:3385-92.

Predictors of Follow-Up Visits Post Radical Prostatectomy

“…Consistent with this study, in a SEER-Medicare cohort, Onukwugha et al reported that Black men with prostate cancer were less likely to see a urologist while married men or those residing in an urban residence were more likely to see a urologist within 1 year of diagnosis ( Onukwugha et al., 2014 ). The results of this study build on Onukwugha et al by examining follow-up visits within 6 months and during the 2nd year in addition to 1st year.…”

“…Few studies have examined receipt of follow-up care specifically among prostate cancer survivors. In a SEER-Medicare study, Onukwugha et al observed that 16% of men with stage I to stage III prostate cancer did not see a urologist within 1 year of diagnosis ( Onukwugha et al, 2014 ). This study builds on previous research by examining predictors of follow-up among prostate cancer patients, including men diagnosed before 65 years of age, in three specific periods including: within 6 months, in the 1st year, and in the 2nd year post surgery.…”

“…The results of this study build on Onukwugha et al by examining follow-up visits within 6 months and during the 2nd year in addition to 1st year. Moreover, Onukwugha et al was limited to elderly men on Medicare (≥ 65 years), with a mean age of prostate cancer diagnosis of 74 years ( Onukwugha et al, 2014 ). By contrast, the mean age at prostate cancer diagnosis in this study was 61, increasing the generalizability of the results to younger men with prostate cancer.…”

Geographical Factors Associated with Health Disparities in Prostate Cancer

“…The geographical and prostate cancer factors found in selected disparity studies have been summarized in the Table. [12][13][14][15][16][17][18][19][20][21][22][23][24][25]…”

“…52 In the field of prostate cancer, research using GIS approaches has been conducted to investigate diagnoses, management, and treatment outcomes across different geographical levels, such as counties, census division/tracts, cancer registry areas, and other aggregate geographical scales. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68] Cockburn et al 53 used the GIS to geocode the historical residential addresses of individuals and measured the association between ambient exposure to pesticide and incidence rates of prostate cancer in California. They found a positive relationship between prostate cancer and ambient pesticide exposure in and around homes in intensely agricultural areas.…”