Advertisement

‘Race’ and Prostate Cancer Mortality in Equal-access Healthcare Systems

  • Author Footnotes
    ∗ TG-S and EU contributed equally to this work.
    Tisheeka Graham-Steed
    Footnotes
    ∗ TG-S and EU contributed equally to this work.
    Affiliations
    Clinical Epidemiology Research Center, Medical Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center, West Haven, Conn

    Department of Medicine, Yale University School of Medicine, New Haven, Conn
    Search for articles by this author
  • Author Footnotes
    ∗ TG-S and EU contributed equally to this work.
    Edward Uchio
    Footnotes
    ∗ TG-S and EU contributed equally to this work.
    Affiliations
    Department of Urology, University of California School of Medicine, Irvine, Irvine
    Search for articles by this author
  • Carolyn K. Wells
    Affiliations
    Clinical Epidemiology Research Center, Medical Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center, West Haven, Conn

    Department of Medicine, Yale University School of Medicine, New Haven, Conn
    Search for articles by this author
  • Mihaela Aslan
    Affiliations
    Clinical Epidemiology Research Center, Medical Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center, West Haven, Conn

    Department of Medicine, Yale University School of Medicine, New Haven, Conn
    Search for articles by this author
  • John Ko
    Affiliations
    Clinical Epidemiology Research Center, Medical Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center, West Haven, Conn
    Search for articles by this author
  • John Concato
    Correspondence
    Requests for reprints should be addressed to John Concato, MD, MS, MPH, Clinical Epidemiology Research Center, VA Connecticut Healthcare System, 950 Campbell Ave, Mail Code 151B, West Haven, CT 06516.
    Affiliations
    Clinical Epidemiology Research Center, Medical Service, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center, West Haven, Conn

    Department of Medicine, Yale University School of Medicine, New Haven, Conn
    Search for articles by this author
  • Author Footnotes
    ∗ TG-S and EU contributed equally to this work.

      Abstract

      Background

      Reports suggest worse health-related outcomes among black (vs white) men diagnosed with prostate cancer, but appropriate cause–effect inferences are complicated by the relationship of race and other prognostic factors.

      Methods

      We searched the literature to find contemporary articles focusing on mortality among black and white men with prostate cancer in equal-access healthcare systems. We also directly assessed the association of race and prostate cancer mortality by conducting an observational cohort analysis of 1270 veterans diagnosed with prostate cancer and followed for 11 to 16 years at 9 medical centers within the Veterans Health Administration.

      Results

      Among 5 reports providing quantitative results for the association of race and mortality among men with prostate cancer in equal-access systems, outcomes were similar for black and white men. Race also was not a prognostic factor in the observational cohort analysis of US veterans, with an adjusted hazard ratio for black (vs white) men and prostate cancer mortality of 0.90 (95% confidence interval, 0.58-1.40; P = .65).

      Conclusions

      Mortality among black and white patients with prostate cancer is similar in equal-access healthcare systems. Studies that find racial differences in mortality (including cause-specific mortality) among men with prostate cancer may not account fully for socioeconomic and clinical factors.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Brawley O.W.
        Prostate cancer epidemiology in the United States.
        World J Urol. 2012; 30: 195-200
        • Hoffman R.M.
        • Gilliland F.D.
        • Eley J.W.
        • et al.
        Racial and ethnic differences in advanced-stage prostate cancer: the Prostate Cancer Outcomes Study.
        J Natl Cancer Inst. 2001; 93: 388-395
        • Taksler G.B.
        • Keating N.L.
        • Cutler D.M.
        Explaining racial differences in prostate cancer mortality.
        Cancer. 2012; 118: 4280-4289
        • Fowler Jr., J.E.
        • Bigler S.A.
        • Bowman G.
        • Kilambi N.K.
        Race and cause specific survival with prostate cancer: influence of clinical stage, Gleason score, age and treatment.
        J Urol. 2000; 163: 137-142
        • Powell I.J.
        • Banerjee M.
        • Novallo M.
        • et al.
        Prostate cancer biochemical recurrence stage for stage is more frequent among African-American than white men with locally advanced but not organ-confined disease.
        Urology. 2000; 55: 246-251
        • Powell I.J.
        • Bock C.H.
        • Ruterbusch J.J.
        • Sakr W.
        Evidence supports a faster growth rate and/or earlier transformation to clinically significant prostate cancer in black than in white American men, and influences racial progression and mortality disparity.
        J Urol. 2010; 183: 1792-1796
        • Cohen J.H.
        • Schoenbach V.J.
        • Kaufman J.S.
        • et al.
        Racial differences in clinical progression among Medicare recipients after treatment for localized prostate cancer (United States).
        Cancer Causes Control. 2006; 17: 803-811
        • Gilligan T.
        • Wang P.S.
        • Levin R.
        • Kantoff P.W.
        • Avorn J.
        Racial differences in screening for prostate cancer in the elderly.
        Arch Intern Med. 2004; 164: 1858-1864
        • Shavers V.L.
        • Brown M.L.
        • Potosky A.L.
        • et al.
        Race/ethnicity and the receipt of watchful waiting for the initial management of prostate cancer.
        J Gen Intern Med. 2004; 19: 146-155
        • Williams D.R.
        Race/ethnicity and socioeconomic status: measurement and methodological issues.
        Int J Health Serv. 1996; 26: 483-505
        • Freedland S.J.
        • Isaacs W.B.
        Explaining racial differences in prostate cancer in the United States: sociology or biology?.
        Prostate. 2005; 62: 243-252
        • Morgan R.O.
        • Teal C.R.
        • Reddy S.G.
        • Ford M.E.
        • Ashton C.M.
        Measurement in Veterans Affairs Health Services Research: veterans as a special population.
        Health Serv Res. 2005; 40: 1573-1583
        • Shen Y.
        • Hendricks A.
        • Zhang S.
        • Kazis L.E.
        VHA enrollees' health care coverage and use of care.
        Med Care Res Rev. 2003; 60: 254-267
        • Concato J.
        • Wells C.K.
        Prostate-specific antigen ‘velocity’ as a diagnostic test for prostate cancer.
        J Investig Med. 2006; 54: 361-364
        • Concato J.
        • Jain D.
        • Uchio E.
        • Risch H.
        • Li W.W.
        • Wells C.K.
        Molecular markers and death from prostate cancer.
        Ann Intern Med. 2009; 150: 595-603
        • Uchio E.M.
        • Aslan M.
        • Wells C.K.
        • Calderone J.
        • Concato J.
        Impact of biochemical recurrence in prostate cancer among US veterans.
        Arch Intern Med. 2010; 170: 1390-1395
        • D’Amico A.V.
        • Whittington R.
        • Schultz D.
        • Malkowicz S.B.
        • Tomaszewski J.E.
        • Wein A.
        Outcome based staging for clinically localized adenocarcinoma of the prostate.
        J Urol. 1997; 158: 1422-1426
        • Optenberg S.A.
        • Thompson I.M.
        • Friedrichs P.
        • Wojcik B.
        • Stein C.R.
        • Kramer B.
        Race, treatment, and long-term survival from prostate cancer in an equal-access medical care delivery system.
        JAMA. 1995; 274: 1599-1605
        • Brawn P.N.
        • Johnson E.H.
        • Kuhl D.L.
        Stage at presentation and survival of white and black patients with prostate carcinoma.
        Cancer. 1993; 71: 2569-2573
        • Powell I.J.
        • Schwartz K.
        • Hussain M.
        Removal of the financial barrier to health care: does it impact on prostate cancer at presentation and survival? A comparative study between black and white men in a Veterans Affairs system.
        Urology. 1995; 46: 825-830
        • Freeman V.L.
        • Durazo-Arvizu R.
        • Arozullah A.M.
        • Keys L.C.
        Determinants of mortality following a diagnosis of prostate cancer in Veterans Affairs and private sector health care systems.
        Am J Public Health. 2003; 93: 1706-1712
        • Jack R.H.
        • Davies E.A.
        • Moller H.
        Prostate cancer incidence, stage at diagnosis, treatment and survival in ethnic groups in South-East England.
        BJU Int. 2010; 105: 1226-1230
        • Evans S.
        • Metcalfe C.
        • Patel B.
        • et al.
        Clinical presentation and initial management of black men and white men with prostate cancer in the United Kingdom: the PROCESS cohort study.
        Br J Cancer. 2010; 102: 249-254
        • Freedland S.J.
        • Sutter M.E.
        • Naitoh J.
        • Dorey F.
        • Csathy G.S.
        • Aronson W.J.
        Clinical characteristics in black and white men with prostate cancer in an equal access medical center.
        Urology. 2000; 55: 387-390
        • Roberts R.
        Debating the cause of health disparities: implications for bioethics and racial equality.
        Camb Q Healthc Ethic. 2012; 21: 332-341
        • Williams D.R.
        • Mohammed S.A.
        • Leavell J.
        • Collins C.
        Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities.
        Ann NY Acad Sci. 2010; 1186: 69-101
        • Kaufman J.S.
        • Cooper R.S.
        • McGee D.L.
        Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race.
        Epidemiology. 1997; 8: 621-628
        • Braveman P.A.
        • Cubbin C.
        • Egerter S.
        • et al.
        Socioeconomic status in health research: one size does not fit all.
        JAMA. 2005; 294: 2879-2888
        • Merrill R.M.
        • Lyon J.L.
        Explaining the difference in prostate cancer mortality rates between white and black men in the United States.
        Urology. 2000; 55: 730-735
        • Peters V.A.
        • Armstrong K.
        Racial differences in prostate cancer treatment outcomes.
        Cancer Nurs. 2005; 28: 108-118