Racial and socioeconomic disparities in surgical care for post-prostate cancer treatment complications: A nationwide Medicare-based analysis

IF 1.6 Q3 UROLOGY & NEPHROLOGY

BJUI compass Pub Date : 2024-02-29 DOI:10.1002/bco2.342

Oluwafolajimi Adesanya, Sirikan Rojanasarot, Alysha M. McGovern, Arthur L. Burnett

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Abstract

Objectives

To investigate the racial and socioeconomic (income) differences in receipt of and time to surgical care for urinary incontinence (UI) and erectile dysfunction (ED) occurring post-radical prostatectomy (RP) and/or radiation therapy (RT).

Materials and Methods

Utilizing the Medicare Standard Analytical Files (SAF), a retrospective cohort study was performed on data of patients diagnosed with prostate cancer (PCa) from 2015 to 2021. Patients who underwent RP and/or RT and who subsequently developed UI and/or ED were grouped into four cohorts: RP-ED, RP-UI, RT-ED and RT-UI. County-level median household income was cross-referenced with SAF county codes, classified into income quartiles, and used as a proxy for patient income status. The rate of surgical care was compared between groups using two-sample t-test and log-rank test. Cox proportional hazards modelling was used to determine covariate-adjusted impact of race on time to surgical care.

Results

The rate of surgical care was 6.8, 3.61 3.07, and 1.54 per 100 person-years for the RP-UI, RT-UI, RP-ED, and RT-ED cohorts, respectively. Cox proportional ‘time-to-surgical care’ regression analysis revealed that Black men were statistically more likely to receive ED surgical care (RP-ED AHR:1.79, 95% CI:1.49–2.17; RT-ED AHR:1.50, 95% CI:1.11–2.01), but less likely to receive UI surgical care (RP-UI AHR:0.80, 95% CI:0.67–0.96) than White men, in all cohorts except RT-UI. Surgical care was highest among Q1 (lowest income quartile) patients in all cohorts except RT-UI.

Conclusions

Surgical care for post-PCa treatment complications is low, and significantly impacted by racial and socioeconomic (income) differences. Prospective studies investigating the basis of these results would be insightful.

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前列腺癌治疗后并发症手术护理中的种族和社会经济差异：基于医疗保险的全国性分析

利用医疗保险标准分析档案（SAF），对 2015 年至 2021 年期间诊断为前列腺癌（PCa）的患者数据进行了一项回顾性队列研究。接受 RP 和/或 RT 术后出现 UI 和/或 ED 的患者被分为四个队列：RP-ED、RP-UI、RT-ED 和 RT-UI。将县级家庭收入中位数与 SAF 县级代码进行交叉比对，划分为收入四分位数，并将其作为患者收入状况的替代指标。使用双样本 t 检验和对数秩检验比较各组之间的手术治疗率。RP-UI、RT-UI、RP-ED 和 RT-ED 组群的手术治疗率分别为每 100 人年 6.8 例、3.61 例、3.07 例和 1.54 例。Cox比例 "手术治疗时间 "回归分析表明，在除RT-UI以外的所有队列中，黑人男性接受ED手术治疗的可能性高于白人男性（RP-ED AHR:1.79，95% CI:1.49-2.17；RT-ED AHR:1.50，95% CI:1.11-2.01），但接受UI手术治疗的可能性低于白人男性（RP-UI AHR:0.80，95% CI:0.67-0.96）。在除 RT-UI 以外的所有队列中，Q1（最低收入四分位数）患者的手术治疗率最高。对这些结果的基础进行前瞻性研究将很有启发。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BJUI compass

CiteScore

2.30

自引率

0.00%

发文量

审稿时长

12 weeks