Understanding the Role of Urology Practice Organization and Racial Composition in Prostate Cancer Treatment...

Area of Science:

• Health Services Research
• Urology
• Health Disparities

Background:

• Black men face higher prostate cancer risks and mortality but receive less definitive treatment.
• Structural factors influencing prostate cancer treatment disparities remain largely unknown.
• Understanding practice organization and racial composition is crucial for actionable insights.

Purpose of the Study:

• To examine associations between urology practice organization, racial composition, and prostate cancer treatment patterns.
• To investigate treatment disparities among Medicare beneficiaries with incident prostate cancer.
• To identify structural factors contributing to racial disparities in prostate cancer care.

Main Methods:

• Utilized a 20% national Medicare data sample (2010-2016) for beneficiaries diagnosed with prostate cancer.
• Linked patients to urology practices based on primary urologist and practice tax identification numbers.
• Grouped practices by proportion of Black patients and employed multilevel mixed-effects models for analysis.

Main Results:

• Identified 54,443 patients across 4,194 practices; 87% White, 9% Black.
• Practices with higher Black patient proportions served lower socioeconomic status patients with higher comorbidity.
• Black patients had lower odds of definitive therapy (aOR 0.87) and lower predicted treatment probability (66% vs. 69% for White patients).

Conclusions:

• Significant prostate cancer treatment disparities persist among Black Medicare beneficiaries despite coverage.
• Findings suggest adverse effects of practice segregation and structural racism on treatment access.
• Multilevel interventions are necessary to address these identified disparities in prostate cancer care.