Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD.Leonard Davis Institute of Health Economics, University of Pennsylvania; University of Pennsylvania School of Medicine; Fox Chase Cancer Center, Philadelphia, PA.
Patients who receive surgery from high-volume surgeons tend to have better outcomes. Black patients, however, are less likely to receive surgery from high-volume surgeons.
Among men with localized prostate cancer, we examined whether disparities in use of high-volume urologists resulted from racial differences in patients being diagnosed by high-volume urologists and/or changing to high-volume urologists for surgery.
Research Design: Retrospective cohort study from Surveillance, Epidemiology, and End Results-Medicare data.
A total of 26,058 black and white men in Surveillance, Epidemiology, and End Results-Medicare diagnosed with localized prostate cancer from 1995 to 2005 that underwent prostatectomy. Patients were linked to their diagnosing urologist and a treating urologist (who performed the surgery).
Diagnosis and receipt of prostatectomy by a high-volume urologist, and changing between diagnosing and treating urologist
After adjustment for confounders, black men were as likely as white men to be diagnosed by a high-volume urologist; however, they were significantly less likely than white men to be treated by a high-volume urologist [odds ratio 0.76; 95% confidence interval (CI), 0.67-0.87]. For men diagnosed by a low-volume urologist, 46.0% changed urologists for their surgery. Black men were significantly less likely to change to a high-volume urologist (relative risk ratio 0.61; 95% CI, 0.47-0.79). Racial differences appeared to reflect black and white patients being diagnosed by different urologists and having different rates of changing after being diagnosed by the same urologists.
Lower rates of changing to high-volume urologists for surgery among black men contribute to racial disparities in treatment by high-volume surgeons.
Pollack CE, Bekelman JE, Epstein AJ, Liao K, Wong YN, Armstrong K. Are you the author?
Reference: Med Care. 2011 Nov;49(11):999-1006.