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Comparative Study
. 2010 Sep;76(3):566-72.
doi: 10.1016/j.urology.2009.10.061. Epub 2010 Feb 16.

Health disparities in staging of SEER-medicare prostate cancer patients in the United States

C Daniel Mullins  1 , Eberechukwu Onukwugha, Kaloyan Bikov, Brian Seal, Arif Hussain
Affiliations
Comparative Study

Health disparities in staging of SEER-medicare prostate cancer patients in the United States

C Daniel Mullins et al. Urology. 2010 Sep.

Abstract

Objectives: To examine whether race or age disparities affected the odds of being staged among prostate cancer (PC) patients. Accurate staging is critical for determining treatment for PC.

Methods: Multivariable logistic regression models examined race and age disparities with respect to the odds of being staged among PC patients using Surveillance, Epidemiology, and End Results-Medicare data. Similar analyses were performed to estimate the adjusted odds of being staged with distant metastatic vs in situ or local/regional disease.

Results: The proportion of patients without staging ranged between 3% and 16% by age and between 6% and 8% by race. Adjusted results demonstrated statistically significant lower odds ratios (P <.05) for 70-74, 75-79, and 80+-year-olds of 0.76, 0.52, and 0.23, respectively, relative to PC patients aged 65-69. The odds of being staged for African Americans are 0.78 times that of non-Hispanic Whites (95% confidence interval = 0.72-0.86). The adjusted probability of distant metastatic disease at initial diagnosis is higher for African Americans (odds ratio = 1.61; 95% confidence interval = 1.47-1.76) and older men with odds ratios of 1.25, 1.85, and 4.33 for ages 70-74, 75-79, and 80+, respectively, compared with 65-69-year-olds (all P <.05).

Conclusions: Even though the overall odds of being staged increased over time, race and age disparities persisted. When staging did occur, the probability of distant metastatic disease was high for African Americans, and there were increasing odds of metastatic disease for all men with advanced age.

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Figures

Figure 1
Figure 1
a Staging Distribution of Elderly SEER-Medicare Prostate Cancer Patients by Race/Ethnicity formula image Unstaged (N=7,158) formula image Distant (N=5,609) formula image Local/Regional (N=101,351) formula image In-situ (N=44) b Staging Distribution of Elderly SEER-Medicare Prostate Cancer Patients by Age formula image Unstaged (N=7,158) formula image Distant (N=5,609) formula image Local/Regional (N=101,351) formula image In-situ (N=44)
See this image and copyright information in PMC

Comment in

  • Editorial comment.
    Modlin CS Jr. Modlin CS Jr. Urology. 2010 Sep;76(3):572-3. doi: 10.1016/j.urology.2009.11.017. Urology. 2010. PMID: 20832605 No abstract available.

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