Inferior Outcomes at Hospitals Serving Disparity Populations for Patients With Prostate Cancer

Researchers, led by Muhieddine Labban, MD, examined receipt of definitive treatment, time to treatment initiation (TTI), and survival of Black and White male patients with prostate cancer (PCa) at hospital systems serving health disparity populations (HSDPs). They found that, while survival was similar between HSDPs and non-HSDPs in patients who received indicated treatments, other variables, such as definitive treatment, TTI within 90 days of diagnosis, and survival, were inferior at HSDPs. Their report was presented at the Society of Urologic Oncology’s 22^nd Annual Meeting.

The study categorized HSDPs as minority-serving hospitals (MSHs)—the facilities with the highest decile of proportion of non-Hispanic Black or Hispanic cancer patients—as well as high-burden safety-net hospitals (SNHs)—the highest quartile of facilities providing care to uninsured cancer patients or patients covered by Medicaid.

The retrospective cohort included Black and White men with intermediate- or high-risk prostate cancer. The primary endpoints assessed were receipt of definitive treatment and TTI within 90 days. The secondary outcome was survival per facility status. Investigators used mixed-effect models to compare the outcomes between HSDPs and non-HSDPs.

The report stated that the proportion of care received at MSHs, high-burden SNHs, and HSDPs was 7.4%, 19.1%, and 21.5%, respectively. Men who were treated at HSDPs were more likely to be non-Hispanic Black (26.4% vs. 11.3%), uninsured (3.8% vs. 0.9%) or with Medicaid coverage (3.8% vs. 0.9%), have an income of less than $38,000 (6.1% vs. 1.5%), and have less than a high school degree (54.6% vs. 34.7%) versus those treated at non-HSDPs. HSDPs were associated with lesser receipt of definitive treatment (odds ratio [OR] = 0.64; 95% confidence interval [CI] 0.57–0.71; P = 0.001) and lower odds for TTI within 90 days (OR = 0.80, 95% CI 0.74–0.86, P = 0.001).

While no difference in survival was found between men who received the indicated therapy at HSDPs versus non-HSDPs (hazard ratio [HR] = 1.03, 95% CI 0.99 –1.07), care at HSDPs was associated with worse survival (hazard ratio [HR] = 1.05, 95% CI 1.02–1.09, P = 0.03).

The study’s authors called for future research to explore how “socioeconomic barriers such as systemic racism and underinsurance contribute to the facility-level gap in access to definitive treatment and overall survival between HSDPs and non-HSDPs.”