Race Impacts Survival, Use of Health Care Resources for Medicaid-Insured Adults With mCSPC

Black or African American men (BAA) have long been disproportionately impacted by health care inequalities in the United States and experience higher overall cancer death rates compared with other racial or ethnic groups. One of the largest disparities exists in prostate cancer (PCa), which disproportionately affects BAA men.

A study by DerSarkissian et al, presented during the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium, assessed the differences in overall survival (OS) and health care resource utilization (HRU) by race in a group of Medicaid-insured patients with metastatic castration-sensitive prostate cancer (mCSPC).

The retrospective, longitudinal cohort study analyzed de-identified administrative claims data from the Centers for Medicare & Medicaid Services 100% Medicaid data files from January 1, 2010, to December 31, 2018. Patients with a diagnosis of PCa, ≥1 claim for androgen deprivation therapy (ADT), diagnosis of metastasis before or within 90 days after ADT, continuous eligibility for ≥6 months pre-index (the defined baseline period), and ≥3 months post-index were included in the study.

The date of first receipt of ADT, novel hormonal therapy, or docetaxel, if initiated within 30 days before ADT, defined the index date. OS and HRU were assessed from the index date to the earliest end of continuous eligibility, data availability, or death. A multivariable Cox proportional hazards model of OS and a multivariable Poisson model of HRU were used and controlled for age, Medicaid plan type, region, median state income, residence in a state with Medicaid expansion, index year, Charlson comorbidity index (CCI), baseline HRU, and clinical characteristics.

A total of 1488 patients with mCSPC were included in the study. Of those patients, 467 (31%) were BAA, 446 (30%) were White, 219 (15%) were Hispanic, and 356 (24%) were other races. Hispanic patients were the oldest, with a mean age of 68 years, followed by patients of other races (67 years), White patients (64 years), and BAA patients (63 years). BAA and Hispanic patients had the highest CCI (0.6), followed by patients of other races (9=0.5) and White patients (0.4).

Median unadjusted OS was 71.3 months for Hispanic patients, 57.1 months for patients of other races, 52.1 months for BAA patients, and 44.9 months for White patients. After adjustment, Hispanic patients had a significantly lower risk of death compared with White patients (hazard ratio [HR], 0.65; 95% CI, 0.43-0.96), and BAA patients had similar survival to White patients (HR, 0.91; 95% CI, 0.69-1.22). Adjusted incidence rate ratios (IRR) showed a significantly lower incidence of PCa-related outpatient (OP) visits for BAA patients compared with White patients (IRR, 0.71; 95% CI, 0.55-0.99) per patient per year. The remaining HRU end points were not significantly different among racial groups.

Of Medicaid-insured patients with mCSPC, Hispanic patients were more likely to live longer than White patients. BAA patients had similar survival and lower rates of PCa-related OP visits compared with White patients, demonstrating differential use of PCa-related health care resources between BAA and White patients.