Racial Differences in Benign Prostatic Hyperplasia Diagnosis and Management in the United States Veteran Population.

Introduction: Benign prostatic hyperplasia (BPH) epidemiology has been broadly investigated. However, less is known about how race affects BPH diagnosis and management. This study analyzed racial trends in the diagnosis and surgical management of BPH among US Veterans.

Methods: Veterans Affairs (VA) Corporate Data Warehouse database was queried from January 1, 2000, to October 20, 2024, to identify Veterans with a diagnosis of BPH. We assessed the rates of BPH procedures and compared trends in diagnosis and surgical management across different demographics including race.

Results: We identified 532,886 Veterans with BPH. Black men were diagnosed at a younger age (63.1 years) compared with White men (66.7 years, P < .01). Black men had a lower rate of surgical management (12.2%) compared with White men (14.6%, P < .01). On Cox regression, Black men had a lower likelihood of surgery when controlling for age and comorbidity status (HR 0.87, 95% CI [0.85-0.89], P < .01). Black men experienced a longer interval between diagnosis and surgery compared with White men (5.2 vs 4.7 years, P < .01). Black men had the lowest rate of transurethral resection of the prostate (65.8%) but had the highest rate of simple prostatectomy (6.7%).

Conclusions: As Veterans have equal health care access through the VA system, our study provides an analysis of BPH management that is unaffected by insurance coverage disparities. Black men were diagnosed with BPH at a younger age, underwent fewer surgical procedures, and had a longer interval between diagnosis and surgery compared with White men. These findings demonstrate significant racial variations, which may contribute to existing racial disparities in healthcare.