Comparing Black and White Patients in Treatment of Advanced Prostate Cancer and Survival in an Equal Access Health System.

IF 3.2 3区医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Journal of Racial and Ethnic Health Disparities Pub Date : 2024-10-21 DOI:10.1007/s40615-024-02217-4

Yvonne L Eaglehouse, Sarah Darmon, Gregory T Chesnut, Craig D Shriver, Kangmin Zhu

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引用次数: 0

Abstract

Background: Racial disparities in prostate cancer treatment and survival in the U.S. have been attributed to differences in access to care and medical insurance. We aimed to compare treatment and survival of advanced prostate cancers between White and Black men in the equal access Military Health System (MHS).

Methods: We accessed the MilCanEpi database to study a cohort of non-Hispanic White and Black men diagnosed with stage III or IV prostate cancer between 1998 and 2014 in the MHS. The racial groups were compared in receiving curative treatment of radical prostatectomy (RP) only, RP with (neo)adjuvant radiation or hormone therapy, radiation only, or combination radiation and hormone therapy; and overall survival using multivariable regression models.

Results: The study included 1476 White and 531 Black men. Overall, there was no racial difference in receiving any curative treatment (AOR = 0.85, 95% CI = 0.67, 1.08 for Black vs. White). By treatment type, Black men were statistically as likely to receive RP only (AOR = 0.87, 95% CI = 0.67, 1.14), radiation only (AOR = 0.81, 95% CI = 0.49, 1.34), or combination radiation and hormone therapy (AOR = 1.12, 95% CI = 0.71, 1.78) but statistically less likely to receive RP with (neo)adjuvant treatment (AOR = 0.56, 95% CI = 0.37, 0.86) relative to no curative treatment compared to White men. The difference in RP with (neo)adjuvant treatment was also statistically significant among patients with stage III tumors, but not stage IV. Survival was similar overall (AHR = 1.12, 95% CI = 0.88, 1.42 for Black vs. White) and when evaluated by tumor stage.

Conclusions: In the MHS, the overall likelihood to receive any treatment for advanced prostate cancers and survival was similar between races, which might result from universal health care. Racial differences in receipt of RP with (neo)adjuvant treatment, especially for patients with stage III prostate cancer, may be related to factors other than access to care and warrants further research.

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比较黑人和白人晚期前列腺癌患者在平等医疗体系中的治疗和生存情况。

背景：在美国，前列腺癌治疗和存活率方面的种族差异被归因于获得医疗服务和医疗保险方面的差异。我们的目的是比较在平等就医的军事医疗系统（MHS）中白人和黑人男性的晚期前列腺癌治疗和生存情况：我们访问了 MilCanEpi 数据库，研究了 1998 年至 2014 年间在军事医疗系统中被诊断为前列腺癌 III 期或 IV 期的非西班牙裔白人和黑人男性队列。使用多变量回归模型比较了种族群体接受根治性前列腺切除术 (RP)、根治性前列腺切除术与（新）辅助放疗或激素疗法、单纯放疗或放疗与激素疗法联合治疗的情况以及总生存率：研究包括 1476 名白人男性和 531 名黑人男性。总体而言，黑人与白人在接受任何根治性治疗方面没有种族差异（AOR = 0.85，95% CI = 0.67，1.08）。按治疗类型划分，黑人男性仅接受 RP（AOR = 0.87，95% CI = 0.67，1.14）、仅接受放射治疗（AOR = 0.81，95% CI = 0.49，1.34）或接受放射和激素联合治疗（AOR = 1.12，95% CI = 0.71，1.78）的可能性与白人男性相同，但与不接受任何根治性治疗相比，黑人男性接受 RP 和（新）辅助治疗（AOR = 0.56，95% CI = 0.37，0.86）的可能性在统计学上较低。在 III 期肿瘤患者中，接受（新）辅助治疗的 RP 的差异也具有统计学意义，但 IV 期肿瘤患者的差异不明显。总体生存率相似（黑人与白人的 AHR = 1.12，95% CI = 0.88，1.42），按肿瘤分期评估时也相似：结论：在MHS中，不同种族接受任何晚期前列腺癌治疗的总体可能性和生存率相似，这可能是全民医疗保健的结果。在接受前列腺癌根治术和（新）辅助治疗方面的种族差异，尤其是对 III 期前列腺癌患者而言，可能与获得医疗服务以外的因素有关，值得进一步研究。

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来源期刊

Journal of Racial and Ethnic Health Disparities PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

7.30

自引率

5.10%

发文量

263

期刊介绍： Journal of Racial and Ethnic Health Disparities reports on the scholarly progress of work to understand, address, and ultimately eliminate health disparities based on race and ethnicity. Efforts to explore underlying causes of health disparities and to describe interventions that have been undertaken to address racial and ethnic health disparities are featured. Promising studies that are ongoing or studies that have longer term data are welcome, as are studies that serve as lessons for best practices in eliminating health disparities. Original research, systematic reviews, and commentaries presenting the state-of-the-art thinking on problems centered on health disparities will be considered for publication. We particularly encourage review articles that generate innovative and testable ideas, and constructive discussions and/or critiques of health disparities.Because the Journal of Racial and Ethnic Health Disparities receives a large number of submissions, about 30% of submissions to the Journal are sent out for full peer review.