Abstract
Background: Though patients who receive surgery from high-volume surgeons tend to have better outcomes, black patients are less likely to receive surgery from high-volume surgeons.
Objective: Among men with localized prostate cancer, we examined whether disparities in use of high-volume urologists resulted from racial differences in patients being diagnosed by high-volume urologists and/or changing to highvolume urologists for surgery.
Research Design: We performed a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) Medicare data. 26,058 black and white men who were diagnosed with localized prostate cancer from 1995 to 2005 and who underwent prostatectomy were included. Patients were linked to both a diagnosing urologist (who submitted a claim nearest the date of diagnosis) and a treating urologist (who performed the surgery). Logistic regression models were used to examine racial differences in diagnosis and treatment by a high versus low volume urologist. Among patients who were diagnosed by a low-volume urologist, multinomial logistic regression models with robust standard errors were used to examine whether patients: (a) did not change physicians (baseline category), (b) changed to a low-volume treating urologist, and (c) changed to a high-volume treating urologist.
Results: Black men were as likely as white men to be diagnosed by a high-volume urologist; however, they were significantly less likely than white men to be treated by a highvolume urologist (Odds ratio 0.76, 95% Confidence Interval [CI] 0.67, 0.87). For men diagnosed by a low-volume urologist, 45.0% changed urologists for their surgery. Black men were less likely to change urologists overall (35.3% versus 45%, p<0.001) and less likely to change to a high-volume urologist than white men (9.1% versus 14.3%, p<0.001). These racial differences in changing providers remained significant in multinomial regression analyses. Racial differences appeared to reflect black and white patients tending to be diagnosed by different urologists (between-provider effects, RRR 0.37, 95%CI 0.18, 0.74) as well as having different rates of changing after being diagnosed by the same urologists (within-provider effects, RRR 0.79, 95%CI 0.66, 0.94).
Conclusions: Lower rates of changing to high-volume urologists for surgery among black men contribute to racial disparities in treatment by high-volume surgeons. The results suggest that interventions that attempt to reduce disparities in access to high-volume surgeons will require a deeper understanding of the specific pathways through which patients come to receive surgical care.
Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A99.
