The impact of racial residential segregation on prostate cancer diagnosis and treatment

Autor: Mark H. Katz, Tracey Dechert, Michael Poulson, Kelly M. Kenzik, Samuel A. Helrich, Teviah E. Sachs
Rok vydání: 2020
Předmět:
Zdroj: BJU International. 127:636-644
ISSN: 1464-410X
1464-4096
DOI: 10.1111/bju.15293
Popis: OBJECTIVES To examine the effects of racial residential segregation and structural racism on the diagnosis, treatment, and outcomes of patients with prostate cancer. PATIENTS AND METHODS This retrospective cohort study examined men diagnosed with prostate cancer between 2005 and 2015. We collected data from Black and White men, aged ≥30 years, living within the 100 most populous counties participating in the Surveillance, Epidemiology, and End Results programme, a nationally representative dataset. The racial Index of Dissimilarity, a validated measure of segregation, was the primary exposure of interest. Outcomes of interest included advanced stage at diagnosis (Stage IV), surgery for localised disease (Stage I-II), and 10-year overall and cancer-specific survival. Multivariable Poisson regression analyses with robust error variance estimated the relative risk (RR) of advanced stage at diagnosis and surgery for localised disease at differing levels of segregation. Survival analysis was performed using competing hazards analysis. RESULTS Multivariable models estimating stage at diagnosis showed that the disparities between Black and White men disappeared at low levels of segregation. Disparities in receiving surgery for localised disease persisted across all levels of segregation. In racially stratified analyses, segregation had no effect on stage at diagnosis or surgical resection for Black patients. White patients saw a 56% (RR 0.42, P
Databáze: OpenAIRE
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