How am I meant to get THERE from HERE?

A new report just published on line in the Journal of Urology has shown that — at least in the state of North Carolina — distance from the nearest urologist affects prostate cancer risk category at diagnosis and may disproportionately impact black as opposed to white patients.

Holmes et al. examined data from the North Carolina Central Cancer Registry and from Medicare claims for 1,720 white and 531 black patients diagnosed with incident prostate cancer diagnosed in 2004 to 2005. They calculated straight-line distances (“as the crow flies”) from patients’ home to the nearest urologist, and then investigated the correlation 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 year of diagnosis.

The base results of their study showed clearly that:

  • The rate of occurrence of high-risk prostate cancer increased with distance to a urologist
    • From 40 percent for men living 0 to 10 miles from a urologist
    • To 45 percent for men living 11 to 20 miles from a urologist
    • To 57 percent for men living > 20 miles from a urologist.
  • Conversely, the rate of occurrence of low-risk prostate cancer decreased with distance to a urologist.
  • Longer distance to a urologist was associated with higher-risk prostate cancer for white and for black patients (p = 0.04 and p < 0.01, respectively).
  • Longer distance to a urologist was associated with a larger impact on the occurrence of higher-risk prostate cancer in black as opposed to white men.

It really doesn’t matter how you want to interpret these data from a “rational” perspective. The fact is that most men tend to avoid going to see doctors if they don’t “really” have to … and if one is otherwise disadvantaged too (that is, other than just being male) it is only going to increase the probability that one will avoid going to see a specialist (until it is potentially “too late”).

One Response

  1. Since I moved to a rural area I have become more aware of access as an issue. There is also a lack of access to primary care MDs. Hospitals in the area have been opening satellite office for primary care but specialty care is much more difficult. Makes sense to me. Men are less likely to go to a primary doctor in rural areas, Therefore they are more likely to be diagnosed with later stage disease. Not sure it is distance to urologist or lack of access to primary care doctors, lack of health education/screening programs, or possibly a cultural difference in rural men? Nice start in identifying an issue in a specific group of men though.

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