Radical Prostatectomy Sociodemographic Disparities Based on Hospital and Physician Volume

The objective of this study was to assess the impact of volume status on socio-demographic disparities for radical prostatectomy (RP) in New York State.

All patients undergoing RP from 2006 to 2014 with an admitting or principal diagnosis of prostate cancer were identified. All 40,533 cases were separated into volume groups stratified by hospital and physician quartiles with a goal of maintaining consistent numbers between the 4 volume groups. Patient-level data included race, ethnicity, Charlson Comorbidity Index (CCI), median income by zip code, and source of payment. Hospital-level data included hospital location, teaching status, health service area, and facility number. Continuous and categorical variables were compared between cohorts using the Mann-Whitney-Wilcoxon test and Pearson χ² tests, respectively. Multivariate regression analysis was conducted to assess predictors of access to very high-volume facilities and physician groups as well as predictors of receiving a minimally invasive RP.

Of 40,533 total cases, 9602 (24%) were conducted at low-volume hospitals, 9208 (22%) were conducted at medium-volume hospitals, 8478 (21%) were conducted at high-volume hospitals, and 13,245 (33%) were conducted at very high-volume hospitals. Negative predictors of receiving care from a very high-volume physician include increased CCI, Asian race, black race, unknown race, Medicaid status, age 65 to 79 years, and age 80 to 130 years (P < .001). Negative predictors of receiving care from a very high-volume facility include Asian race, black race, unknown race, Medicaid status, and self-payment status (P < .001).

Socioeconomic disparities exist in New York State for RP and are associated with disadvantaged groups being overrepresented in low-volume hospital and physician groups.