Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Nov;49(11):999-1006.
doi: 10.1097/MLR.0b013e3182364019.

Racial disparities in changing to a high-volume urologist among men with localized prostate cancer

Craig Evan Pollack  1 , Justin E Bekelman, Andrew J Epstein, Kaijun Liao, Yu-Ning Wong, Katrina Armstrong
Affiliations

Racial disparities in changing to a high-volume urologist among men with localized prostate cancer

Craig Evan Pollack et al. Med Care. 2011 Nov.

Abstract

Background: Patients who receive surgery from high-volume surgeons tend to have better outcomes. Black patients, however, are less likely to receive surgery from high-volume surgeons.

Objective: Among men with localized prostate cancer, we examined whether disparities in use of high-volume urologists resulted from racial differences in patients being diagnosed by high-volume urologists and/or changing to high-volume urologists for surgery.

Research design: Retrospective cohort study from Surveillance, Epidemiology, and End Results-Medicare data.

Subjects: A total of 26,058 black and white men in Surveillance, Epidemiology, and End Results-Medicare diagnosed with localized prostate cancer from 1995 to 2005 that underwent prostatectomy. Patients were linked to their diagnosing urologist and a treating urologist (who performed the surgery).

Measures: Diagnosis and receipt of prostatectomy by a high-volume urologist, and changing between diagnosing and treating urologist

Results: After adjustment for confounders, black men were as likely as white men to be diagnosed by a high-volume urologist; however, they were significantly less likely than white men to be treated by a high-volume urologist [odds ratio 0.76; 95% confidence interval (CI), 0.67-0.87]. For men diagnosed by a low-volume urologist, 46.0% changed urologists for their surgery. Black men were significantly less likely to change to a high-volume urologist (relative risk ratio 0.61; 95% CI, 0.47-0.79). Racial differences appeared to reflect black and white patients being diagnosed by different urologists and having different rates of changing after being diagnosed by the same urologists.

Conclusions: Lower rates of changing to high-volume urologists for surgery among black men contribute to racial disparities in treatment by high-volume surgeons.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Patient pathways according to volume of diagnosing and treating urologists, accounting for patient race and changing physicians
See this image and copyright information in PMC

References

    1. Halm EA, Lee C, Chassin MR. Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature. Ann Intern Med. 2002;137(6):511–520. - PubMed
    1. Chowdhury MM, Dagash H, Pierro A. A systematic review of the impact of volume of surgery and specialization on patient outcome. Br J Surg. 2007;94(2):145–161. - PubMed
    1. Gooden KM, Howard DL, Carpenter WR, et al. The Effect of Hospittal and Surgeon Colume on Racial Differences in Recurrence-Free Survival After Radical Prostatectomy. Med Care. 2008;46:1170–1176. - PMC - PubMed
    1. Sosa JA, Mehta PJ, Wang TS, Yeo HL, Roman SA. Racial Disparities in Clinical and Economic Outcomes from Thyroidectomy. Ann Surg. 2007;246:1983–1991. - PubMed
    1. Epstein AJ, Gray BH, Schlesinger M. Racial and Ethnic Differences in the Use of High-Volume Hospitals and Surgeons. Arch Surg. 2010;145(2):179–186. - PubMed

Publication types

MeSH terms