Study explores impact of clinical and access factors on racial disparities in prostatectomy outcomes

Disparities in mortality rates between Black and White patients receiving radical prostatectomy were significantly lower, but not erased, after statistical modeling adjusted for clinical factors and healthcare access issues. Following the same adjustments, the survival disparity between Asian Americans and Pacific Islanders (AAPIs) and White patients significantly increased.¹

According to the analysis, which was published in Cancer, when adjusting for only age and year of diagnosis, the mortality rate was 51% higher for Black patients receiving the procedure; however, when the model adjusted for all clinical and nonclinical factors, this survival disparity dropped to 20%. Conversely, the AAPI-White disparity in survival was 22% when adjusting for age and diagnosis year alone, and increased to 35% when also adjusting for all of the other factors. Of note, Hispanic patients had a 6% lower mortality compared to white patients with the initial adjustments, and that rate was relatively unaffected by the additional adjustments.

“As shown in this study, if Blacks had similar education levels, median household income, and insurance status, the survival disparity between Blacks and whites would decrease from 51% to 30%,” the authors noted. “Unfortunately, income inequality in the United States has continued to increase over the past 4 decades and may result in rising health inequalities.”

The study investigators reviewed data from the National Cancer Database for 526,690 patients with prostate cancer who underwent radical prostatectomy between 2004 and 2014. Their aim was to systemically evaluate the effect of patients’ clinical factors and healthcare access issues on mortality rates by race. The study population comprised 432,640 (82.1%) White patients, 63,602 (12.1%) Black patients, 8990 (1.7%) AAPI patients, and 21,458 (4.1%) Hispanic patients.

“Our findings are consistent with recent reports showing that racial disparities are greatest among patients with low-grade Gleason 6 disease, with Black men twice as likely to die of prostate cancer as non-Black men, and Black patients with low-risk prostate cancer are more likely to harbor higher risk disease, which may lead to adverse outcomes,” the authors explained. “These findings suggest that during individualized counseling for men with low-risk prostate cancer, race should be considered when treatment options are being discussed.”

Of note, the nonclinical factors that contributed the most to the racial disparities in mortality were education, median household income, and insurance status.

Importantly, a major limitation of this study was missing information on cancer recurrence and causes of death. Therefore, the investigators could not analyze the cause-specific mortality. Additionally, the study had a relatively short follow-up time of only 5.5 years.

Going forward, the researchers recommended other health-related factors such as genetic and lifestyle factors like smoking, drinking, obesity, and physical inactivity that were not evaluated in this study be investigated for their contribution to the racial survival disparity. Further, it was suggested that future “studies with cause-specific mortality and longer follow-up times are warranted to further investigate racial disparities in the cancer-specific survival of prostate patients.”

Reference

1. Wen W, Luckenbaugh AN, Bayley CE, Pension DF, Shu X. Racial Disparities in Mortality for Patients With Prostate Cancer After Radical Prostatectomy [published online September 8, 2020]. Cancer. doi: 10.1002/cncr.33152