Racial disparities in the receipt of therapies for cancer, hypertension, and diabetes, and in mortality in a large population-based cohort of older men with prostate cancer.

Abstract

Background: Racial disparities in treatment and mortality were widely studied among prostate cancer patients; however, few studies considered the prevalence of hypertension and diabetes and their treatment status.

Objectives: To determine whether there are racial discrepancies in the use of anti-cancer, antihypertensive, and antidiabetic drugs in a cohort of long-term survivors of prostate cancer diagnosed in 2007-2015; and to examine racial disparities in mortality after adjustments for their differences in those treatments.

Methods: We used the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database and included records for patients with prostate cancer at age 65 years or older diagnosed from 2007 to 2015 in 17 SEER areas (n = 244,468).

Results: Among non-Hispanic Blacks with prostate cancer, 86.2% were affected by hypertension, with 62.1% taking antihypertensive medications. Additionally, 45.3% of individuals in this group had diabetes, and 41.1% of them received antidiabetic drugs to manage their respective health conditions. Non-Hispanic Blacks were less likely to receive antihypertensive drugs (adjusted odds ratio [aOR]: 0.94, 95% confidence interval [CI]: 0.89-0.99) and antidiabetic drugs (aOR:0.86, 95% CI:0.80-0.92) compared with non-Hispanic Whites. Hispanic and non-Hispanic Asians were significantly less likely to receive chemotherapy and hormone therapy, compared with non-Hispanic Whites. After adjusting for all factors including treatments, the risk of all-cause and cancer-specific mortality was significantly higher for non-Hispanic Blacks (hazard ratio: 1.22, 95% CI: 1.24-1.51 and 1.22, 95% CI:1.17-1.27) than that of non-Hispanic Whites.

Conclusions: There were substantial racial disparities in the receipt of cancer treatments and antihypertension and antidiabetic drugs. Non-Hispanic Black patients with prostate cancer still had a considerably higher risk of all-cause and cancer-specific mortality than non-Hispanic Whites after accounting for demographic, therapy, and tumor factors.