Article

Impact of Distance to a Urologist on Early Diagnosis of Prostate Cancer Among Black and White Patients

Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
The Journal of urology (Impact Factor: 3.75). 03/2012; 187(3):883-8. DOI: 10.1016/j.juro.2011.10.156
Source: PubMed

ABSTRACT We examined whether an increased distance to a urologist is associated with a delayed diagnosis of prostate cancer among black and white patients, as manifested by higher risk disease at diagnosis.
North Carolina Central Cancer Registry data were linked to Medicare claims for patients with incident prostate cancer diagnosed in 2004 to 2005. Straight-line distances were calculated from the patient home to the nearest urologist. Race stratified multivariate ordinal logistic regression was used to examine the association between distance to a urologist and prostate cancer risk group (low, intermediate, high or very high/metastasis) at diagnosis for black and white patients while accounting for age, comorbidity, marital status and diagnosis year. An overall model was then used to examine the distance × race interaction effect.
Included in analysis were 1,720 white and 531 black men. In the overall cohort the high risk cancer rate increased monotonically with distance to a urologist, including 40% for 0 to 10, 45% for 11 to 20 and 57% for greater than 20 miles. Correspondingly the low risk cancer rate decreased with longer distance. On race stratified multivariate analysis longer distance was associated with higher risk prostate cancer for white and black patients (p = 0.04 and <0.01, respectively) but the effect was larger in the latter group. The distance × race interaction term was significant in the overall model (p = 0.03).
Longer distance to a urologist may disproportionally impact black patients. Decreasing modifiable barriers to health care access, such as distance to care, may decrease racial disparities in prostate cancer.

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    • "Closest to cancer centres Closest to primary care Holmes et al., 2012 NC, USA 2004-2005 2,251 Furthest from Urologists Jemal et al., 2005 USA 1995-2000 NS Rural Jong et al., 2004 NSW, Australia 1992-1996 NS Rural Major et al., 2012 USA 1995-2006 22,523 Areas with fewer Urologists McLafferty and Wang, 2009 Illinois, USA 1998-2002 42,291 Rural Robson et al., 2010 New Zealand 1996-2006 29,185 No difference Skolarus et al., 2013 USA 2008 11,368 No difference Xiao et al., 2011 Florida, USA 1996-2002 60,289 Rural Yu et al., 2014b NSW, Australia 1982-2007 68,686 Rural Area disadvantage differentials Byers et al., 2008 7 States, USA 1997 4,332 Disadvantaged Chu et al., 2012 3 States, USA 1989-2010 2,502 Disadvantaged Haynes et al., 2008 New Zealand 1994-2004 25,078 No difference Liu et al., 2001 Los Angeles, USA 1972-1997 83,068 No difference (1972-1986) Disadvantaged (1987-1997) Lyratzopoulos et al., 2010 UK 1998-2006 15,916 Disadvantaged Niu et al., 2010 New Jersey, USA 1986-1999 69,417 Disadvantaged Robson et al., 2010 New Zealand 1996-2006 29,185 Disadvantaged (non-Maori), equal (Maori) Schwartz et al., 2003 Detroit, USA 1988-1992 11,896 Disadvantaged Singh et al., 2003 USA 1975-1999 NS Disadvantaged *NS: Not stated; NC: North Carolina In contrast, a study of US veterans diagnosed with prostate cancer in 2008 found no difference between urban or rural patients in relation to tumour grade or stage (Skolarus et al., 2013). When considering area disadvantage, an analysis of men undergoing radical prostatectomy between 1989 and 2010 at several equal-access Veteran Affairs Medical Centres in California, Georgia and North Carolina found that men living in areas with lower socioeconomic status were more likely to have high grade disease than those men living in more affluent areas (Chu et al., 2012). "
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    ABSTRACT: BACKGROUND: This study reviewed the published evidence as to how prostate cancer outcomes vary across geographical remoteness and area level disadvantage. MATERIALS AND METHODS: A review of the literature published from January 1998 to January 2014 was undertaken: Medline and CINAHL databases were searched in February to May 2014. The search terms included terms of 'Prostate cancer' and 'prostatic neoplasms' coupled with 'rural health', 'urban health', 'geographic inequalities', 'spatial', 'socioeconomic', 'disadvantage', 'health literacy' or 'health service accessibility'. Outcome specific terms were 'incidence', 'mortality', 'prevalence', 'survival', 'disease progression', 'PSA testing' or 'PSA screening', 'treatment', 'treatment complications' and 'recurrence'. A further search through internet search engines was conducted to identify any additional relevant published reports. RESULTS: 91 papers were included in the review. While patterns were sometimes contrasting, the predominate patterns were for PSA testing to be more common in urban (5 studies out of 6) and affluent areas (2 of 2), higher prostate cancer incidence in urban (12 of 22) and affluent (18 of 20), greater risk of advanced stage prostate cancer in rural (7 of 11) and disadvantaged (8 of 9), higher survival in urban (8 of 13) and affluent (16 of 18), greater access or use of definitive treatment services in urban (6 of 9) and affluent (7 of 7), and higher prostate mortality in rural (10 of 20) and disadvantaged (8 of 16) areas. CONCLUSIONS: Future studies may need to utilise a mixed methods approach, in which the quantifiable attributes of the individuals living within areas are measured along with the characteristics of the areas themselves, but importantly include a qualitative examination of the lived experience of people within those areas. These studies should be conducted across a range of international countries using consistent measures and incorporate dialogue between clinicians, epidemiologists, policy advocates and disease control specialists.
    Asian Pacific journal of cancer prevention: APJCP 03/2015; 16. · 2.51 Impact Factor
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    • "Closest to cancer centres Closest to primary care Holmes et al., 2012 NC, USA 2004-2005 2,251 Furthest from Urologists Jemal et al., 2005 USA 1995-2000 NS Rural Jong et al., 2004 NSW, Australia 1992-1996 NS Rural Major et al., 2012 USA 1995-2006 22,523 Areas with fewer Urologists McLafferty and Wang, 2009 Illinois, USA 1998-2002 42,291 Rural Robson et al., 2010 New Zealand 1996-2006 29,185 No difference Skolarus et al., 2013 USA 2008 11,368 No difference Xiao et al., 2011 Florida, USA 1996-2002 60,289 Rural Yu et al., 2014b NSW, Australia 1982-2007 68,686 Rural Area disadvantage differentials Byers et al., 2008 7 States, USA 1997 4,332 Disadvantaged Chu et al., 2012 3 States, USA 1989-2010 2,502 Disadvantaged Haynes et al., 2008 New Zealand 1994-2004 25,078 No difference Liu et al., 2001 Los Angeles, USA 1972-1997 83,068 No difference (1972-1986) Disadvantaged (1987-1997) Lyratzopoulos et al., 2010 UK 1998-2006 15,916 Disadvantaged Niu et al., 2010 New Jersey, USA 1986-1999 69,417 Disadvantaged Robson et al., 2010 New Zealand 1996-2006 29,185 Disadvantaged (non-Maori), equal (Maori) Schwartz et al., 2003 Detroit, USA 1988-1992 11,896 Disadvantaged Singh et al., 2003 USA 1975-1999 NS Disadvantaged *NS: Not stated; NC: North Carolina In contrast, a study of US veterans diagnosed with prostate cancer in 2008 found no difference between urban or rural patients in relation to tumour grade or stage (Skolarus et al., 2013). When considering area disadvantage, an analysis of men undergoing radical prostatectomy between 1989 and 2010 at several equal-access Veteran Affairs Medical Centres in California, Georgia and North Carolina found that men living in areas with lower socioeconomic status were more likely to have high grade disease than those men living in more affluent areas (Chu et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study reviewed the published evidence as to how prostate cancer outcomes vary across geographical remoteness and area level disadvantage. A review of the literature published from January 1998 to January 2014 was undertaken: Medline and CINAHL databases were searched in February to May 2014. The search terms included terms of 'Prostate cancer' and 'prostatic neoplasms' coupled with 'rural health', 'urban health', 'geographic inequalities', 'spatial', 'socioeconomic', 'disadvantage', 'health literacy' or 'health service accessibility'. Outcome specific terms were 'incidence', 'mortality', 'prevalence', 'survival', 'disease progression', 'PSA testing' or 'PSA screening', 'treatment', 'treatment complications' and 'recurrence'. A further search through internet search engines was conducted to identify any additional relevant published reports. 91 papers were included in the review. While patterns were sometimes contrasting, the predominate patterns were for PSA testing to be more common in urban (5 studies out of 6) and affluent areas (2 of 2), higher prostate cancer incidence in urban (12 of 22) and affluent (18 of 20), greater risk of advanced stage prostate cancer in rural (7 of 11) and disadvantaged (8 of 9), higher survival in urban (8 of 13) and affluent (16 of 18), greater access or use of definitive treatment services in urban (6 of 9) and affluent (7 of 7), and higher prostate mortality in rural (10 of 20) and disadvantaged (8 of 16) areas. Future studies may need to utilise a mixed methods approach, in which the quantifiable attributes of the individuals living within areas are measured along with the characteristics of the areas themselves, but importantly include a qualitative examination of the lived experience of people within those areas. These studies should be conducted across a range of international countries using consistent measures and incorporate dialogue between clinicians, epidemiologists, policy advocates and disease control specialists.
    Asian Pacific journal of cancer prevention: APJCP 03/2015; 16(3):1259-75. DOI:10.7314/APJCP.2015.16.3.1259 · 2.51 Impact Factor
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    ABSTRACT: The purpose of this study was to separately examine the impact of neighborhood socioeconomic deprivation and availability of healthcare resources on prostate cancer risk among African American and Caucasian men. In the large, prospective NIH-AARP Diet and Health Study, we analyzed baseline (1995-1996) data from adult men, aged 50-71 years. Incident prostate cancer cases (n = 22,523; 1,089 among African Americans) were identified through December 2006. Lifestyle and health risk information was ascertained by questionnaires administered at baseline. Area-level socioeconomic indicators were ascertained by linkage to the US Census and the Area Resource File. Multilevel Cox models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs). A differential effect among African Americans and Caucasians was observed for neighborhood deprivation (p-interaction = 0.04), percent uninsured (p-interaction = 0.02), and urologist density (p-interaction = 0.01). Compared to men living in counties with the highest density of urologists, those with fewer had a substantially increased risk of developing advanced prostate cancer (HR = 2.68, 95 % CI = 1.31, 5.47) among African American. Certain socioeconomic indicators were associated with an increased risk of prostate cancer among African American men compared to Caucasians. Minimizing differences in healthcare availability may be a potentially important pathway to minimizing disparities in prostate cancer risk.
    Cancer Causes and Control 07/2012; 23(7):1185-91. DOI:10.1007/s10552-012-9988-8 · 2.96 Impact Factor
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