Low insurance, high risk (for prostate cancer mortality among African Americans)

A recently published paper in the journal Urologic Oncology has confirmed that (regrettably but unsurprisingly), here in the USA, African-American men with high-risk prostate cancer are significantly less likely than white males to be given definitive treatment with curative intent.

The reasons for this are certainly complex, and undoubtedly include a variety of socio-economic, regional, cultural, and financial factors. However, the bottom line is that such a social failure to ensure that any man in America today would not be able to receive high-quality curative care for high-risk prostate cancer is and should be unacceptable, and the prostate cancer community and the African-American community should be working together to overcome such a social failure.

Mahal et al. looked, most particularly, at whether access to health insurance was associated with a reduction in racial disparity with respect to the application of definitive and potentially curative therapy for men diagnosed with high-risk prostate cancer.

They used data from the Surveillance, Epidemiology, and End Results (SEER) program to identify just over 70,000 men diagnosed between 2007 and 2010 with localized, high-risk prostate cancer (PSA level > 20 ng/ml or Gleason score 8-10 or clinical stage >cT3a).

Here are the key results that they report:

  • For 64,277/70,006 patients, sufficiently complete data were available to determine factors associated with receipt of definitive therapy.
  • Compared with white men, after adjustments for relevant socio-demographic and known prognostic factors, African-American men were significantly less likely to receive definitive treatment (adjusted odds ratio [aOR] = 0.60; P < 0.001)
  • Insurance coverage was associated with a statistically significant reduction in racial disparity between African-American and white patients regarding receipt of definitive therapy:
    • Among uninsured men, the aOR for definitive treatment for African-American vs. white males was 0.38 (P < 0.001).
    • Among insured men, the aOR for definitive treatment for African-American vs. white males was 0.62 (P < 0.001).

Mahal et al. conclude that (in the period  2007 through 2010) African-American males diagnosed with high-risk prostate cancer

were significantly less likely to receive potentially life-saving definitive treatment when compared with white men. Having health insurance was associated with a reduction in this racial treatment disparity, suggesting that expansion of health insurance coverage may help reduce racial disparities in the management of aggressive cancers.

Our ability to overcome this problem is going to be challenging — particularly in the current economic and political environment. Many African-Americans have either no insurance or (at best) Medicaid coverage until they become eligible for Medicare. However, high-risk prostate cancer is commonly diagnosable in men who haven’t reached Medicare eligibility. As a consequence it may not get either diagnosed or treated earlier enough … or worse still it may get diagnosed but remain untreated because, from the patient’s perspective, treatment is unaffordable.

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