We thank Pharmaceutical Research Computing and Candice Yong for programming assistance on the primary data sets. The current study used the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. We acknowledge the efforts of the Applied Research Program of the National Cancer Institute; the Office of Research, Development and Information of the Centers for Medicare and Medicaid Services; Information Management Services, Inc; and the SEER Program tumor registries in the creation of the SEER-Medicare database. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.
Racial disparities in urologist visits among elderly men with prostate cancer: A cohort analysis of patient-related and county of residence-related factors
Article first published online: 24 JUN 2014
© 2014 American Cancer Society
Volume 120, Issue 21, pages 3385–3392, November 1, 2014
How to Cite
Onukwugha, E., Osteen, P., Jayasekera, J., Mullins, C. D., Mair, C. A. and Hussain, A. (2014), Racial disparities in urologist visits among elderly men with prostate cancer: A cohort analysis of patient-related and county of residence-related factors. Cancer, 120: 3385–3392. doi: 10.1002/cncr.28894
- Issue published online: 20 OCT 2014
- Article first published online: 24 JUN 2014
- Manuscript Accepted: 9 MAY 2014
- Manuscript Revised: 28 APR 2014
- Manuscript Received: 28 OCT 2013
- prostate cancer;
- social environment
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.
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.
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.
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;120:3385–3392. © 2014 American Cancer Society.