Difference in the quality of care may contribute to the less optimal prostate cancer treatment outcomes among Blacks compared with Whites. Our objective was to determine whether a racial quality of care gap exists in surgical care for prostate cancer, as evidenced by racial variation in the utilization of high-volume surgeons and facilities, and in certain outcome measures of care quality.
Materials and Methods
We performed cross-sectional and cohort analyses of administrative data from the Healthcare Cost and Utilization Project's all-payer State Inpatient Databases, encompassing all non-Federal hospitals in Florida, Maryland and New York State (1996-2007). Included were men 18 or older with a diagnosis of prostate cancer who underwent radical prostatectomy. We compared use of surgeons and/or hospitals in the top quartile of annual volume for this procedure, inpatient blood transfusion, complications, mortality and length of stay (LOS) between Black and White patients.
Among 105,972 cases, 81,112 (76.5%) were White, 14,006 (13.2%) were Black, 6,999 (6.6%) were Hispanic and 3,855 (3.6%) were All Other. In mixed effects multivariate models, Blacks had markedly lower use of high-volume hospitals (Odds Ratio [OR] = 0.73, 95% Confidence interval [0.70, 0.76]), and surgeons (0.67 [0.64, 0.70]) compared to Whites. Blacks also had a higher odds of receiving a blood transfusion (1.08 [1.01, 1.14]), of longer LOS (1.07 [1.06, 1.07]) and of inpatient mortality (1.73 [1.02, 2.92]).
Using an all-payer dataset, we identified concerning potential quality of care gaps between Blacks and Whites undergoing radical prostatectomy for prostate cancer.