Racial Differences in Survival and Healthcare Resource Utilization Among Medicaid-Insured Adults With Metastatic...

Racial disparities in prostate cancer (PC) are well studied among Black or African American (BAA) patients but not among Hispanics, a quickly growing US minority group. This study compared overall survival (OS) and healthcare resource utilization (HRU) by race in Medicaid-insured patients with metastatic castration-sensitive PC (mCSPC) and metastatic castration-resistant PC (mCRPC).

A retrospective longitudinal cohort study of Medicaid claims was conducted to estimate racial disparities in OS (with a multivariable Cox proportional hazards model) and in HRU (with a multivariable Poisson model), adjusting for confounding by demographic and clinical characteristics. Analyses were conducted separately for mCSPC and mCRPC.

The study included 1,253 mCSPC patients (BAA: N = 467; White: N = 446; Hispanic: N = 219; Other races: N = 121) and 871 mCRPC patients (BAA: N = 278; White: N = 320; Hispanic: N = 190; Other races: N = 83). Among mCSPC patients, Hispanic patients had significantly longer adjusted survival vs. White patients (hazard ratio (HR); 95% confidence interval: 0.63; 0.42-0.94). BAA and White patients had comparable survival (0.87; 0.66-1.15). BAA patients had lower rates of adjusted PC-related outpatient (OP) visits vs. White patients (incidence rate ratios [IRR] 0.72; 0.55-0.96). Among mCRPC patients, Hispanic patients had longer survival vs. White patients (HR: 0.63; 0.43-0.93). BAA and White patients had comparable survival (HR: 0.84; 0.62-1.14). BAA patients had significantly fewer PC-related OP visits vs. White patients (IRR: 0.71; 0.55-0.92) and significantly more PC-related emergency room (ER) visits (IRR: 5.41; 1.94-15.09) and inpatient admissions (IRR: 1.90; 1.10-3.25).

White and BAA Medicaid-insured patients with mCSPC and mCRPC had similar survival outcomes, whereas Hispanic patients, an under-studied minority group, had significantly longer survival compared to White patients. Differential HRU was observed among racial groups to different extents in the mCSPC and mCRPC cohorts. Further studies are needed to understand the relation between racial disparities in HRU and OS.