Abstract PO-211: Racial disparities in the quality of surgical care among Medicare beneficiaries with prostate cancer
Authors: Nyame Yaw A. , Holt Sarah K. , Etzioni Ruth , Gore John L. 
Published: December 2020

Abstract
Background: Black men in the US demonstrate a two-fold increase in prostate cancer mortality compared to men of other races/ethnicities. The aim of this analysis was to understand how access to high quality care—estimated using surgical volume— impacts disparities in prostate cancer mortality between Black and White men with localized prostate cancer. Methods: This is an analysis of a SEER-Medicare cohort of men diagnosed with localized prostate cancer (cT1-4N0M0) managed primarily by radical prostatectomy from 2005-2015. This analysis was restricted to Black and White men due to low representative numbers of men of other races/ethnicities.
Social, demographic, and clinical data were obtained. Both facility and provider data were obtained using administrative data in Medicare. Surgical volume for both providers and facilities were stratified into low, medium, and high. Simple descriptive analyses were performed. Multivariable Cox regression analyses was used to assess the relationship between race, surgical volume, and various clinical and social variables. Results: Black men represented 2,070 (7.1%) of the 29,071 men in this cohort. Black men in the cohort had a higher proportion of prostate specific antigen (PSA) greater than 20 ng/mL (7.0% vs 3.6%) and a higher proportion of men with cT1 disease at diagnosis (64.6% vs 56.1%) when compared to White men. Black men were also less likely to be married/partnered (63.5% vs. 79.9%), more likely to reside in an impoverished zip code (43.9% vs. 11.1%), and more likely to have significant comorbidities (7.2% vs. 2.9%). Black men in this cohort were most likely to be treated in the Southern US (42.8% of cases). Black men were more likely to be treated at a minority serving hospital/facility (24.6% vs. 3.1%, p &lt; 0.001), more likely to be treated at a very large hospital/health system (p &lt; 0.001), and less likely to be treated by a high-volume surgeon or facility (7.7% vs. 19.9%, p &lt; 0.001) compared to White men. On multivariable analysis adjusted for race, hospital type, NCI comorbidity index, clinical stage, and prostatectomy volume; black men demonstrated an increased risk of prostate cancer mortality (hazard ratio 1.27, 95% CI 0.94, 1.72) compared to White men. On stratified analysis, there were no racial disparities in cancer-specific mortality among men treated by a high-volume provider/facility. In contrast, Black men treated by a low/medium volume provider/facility had a higher likelihood of prostate cancer related death following surgery (hazard ratio 1.41, 95% CI 1.02, 1.95, p = 0.04). Conclusions: Black Medicare beneficiaries with prostate cancer demonstrate unique patterns of surgical care utilization, with differences noted in the types and surgical volumes—and likely surgical quality—of their health facilities and providers. Our findings suggest that access to high-quality prostate cancer care is an important mediator of racial disparities in prostate cancer, even among men with access to health insurance.
Citation Format: Yaw A. Nyame, Sarah K. Holt, Ruth Etzioni, John L. Gore. Racial disparities in the quality of surgical care among Medicare beneficiaries with prostate cancer [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-211.