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Hospital racial composition and the treatment of localized prostate cancer†

  1. Craig Evan Pollack MD, MHS1,2,3,‡,*,
  2. Justin E. Bekelman MD4,
  3. K. J. Liao MS5,
  4. Katrina Armstrong MD, MSCE3,5

Article first published online: 20 JUN 2011

DOI: 10.1002/cncr.26232

Issue

Cancer

Cancer

Volume 117, Issue 24, pages 5569–5578, 15 December 2011

Additional Information

How to Cite

Pollack, C. E., Bekelman, J. E., Liao, K. J. and Armstrong, K. (2011), Hospital racial composition and the treatment of localized prostate cancer. Cancer, 117: 5569–5578. doi: 10.1002/cncr.26232

Author Information

  1. 1

    Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

  2. 2

    Bloomberg School of Public Health, Baltimore, Maryland

  3. 3

    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

  4. 4

    Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

  5. 5

    Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

  1. ‡

    Fax: (410) 955-0476

*Johns Hopkins School of Medicine, 2024 E. Monument Street, Rm 2-615, Baltimore, MD 21287

  1. †

    We thank the Applied Research Program, National Cancer Institute; Office of Research, Development, and Information, Centers for Medicare and Medicaid Services; and Mary Ellen Slaughter for statistical advice.

  2. ‡

    Fax: (410) 955-0476

Publication History

  1. Issue published online: 2 DEC 2011
  2. Article first published online: 20 JUN 2011
  3. Manuscript Accepted: 12 APR 2011
  4. Manuscript Revised: 10 MAR 2011
  5. Manuscript Received: 25 JAN 2011

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Keywords:

  • prostate cancer;
  • disparities;
  • race and ethnicity;
  • hospital

Abstract

BACKGROUND:

Racial differences in the treatment of men with localized prostate cancer remain poorly understood. This study examines whether hospital racial composition is associated with the type of treatment black and white men receive.

METHODS:

The authors performed a retrospective cohort study of men in Surveillance, Epidemiology, and End Results-Medicare diagnosed with localized prostate cancer from 1995 to 2005 linked to hospital and census data. A total of 134,291 men were assigned to the hospital where they received care. Generalized estimating equations were used to determine whether hospital racial composition was associated with the receipt of definitive therapy and type of treatment.

RESULTS:

Black men were less likely to receive radiation and/or prostatectomy compared with white men (55.5% vs 63.7%, P < .001) and, among those who received definitive therapy, were less likely to undergo prostatectomy (27.5% vs 31.9%, P < .001). The percentage of black men who received their care at hospitals with a high proportion of black patients was 48.0%, compared with only 5.2% of white patients who received care in this subset of hospitals. Men were significantly less likely to receive definitive treatment (odds ratio, 0.81; 95% confidence interval, 0.74-0.90) in hospitals with a high proportion of black patients compared with men seen at hospitals with fewer black patients. The association between hospital racial composition and treatment did not significantly differ by patient race.

CONCLUSIONS:

Hospital racial composition is consistently associated with the care that men receive for localized prostate cancer. Better understanding of the factors that determine where men receive care is an important component in reducing variation in treatment. Cancer 2011;. © 2011 American Cancer Society.

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