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
. 2020 Apr 15;126(8):1683-1690.
doi: 10.1002/cncr.32666. Epub 2020 Jan 27.

Survival of African American and non-Hispanic white men with prostate cancer in an equal-access health care system

Paul Riviere  1   2 , Elaine Luterstein  1 , Abhishek Kumar  1 , Lucas K Vitzthum  1   2 , Rishi Deka  1   2 , Reith R Sarkar  1   2 , Alex K Bryant  1 , Andrew Bruggeman  1 , John P Einck  1 , James D Murphy  1   2 , María Elena Martínez  3 , Brent S Rose  1   2
Affiliations
Free article

Survival of African American and non-Hispanic white men with prostate cancer in an equal-access health care system

Paul Riviere et al. Cancer. .
Free article

Abstract

Background: African American (AA) men in the general US population are more than twice as likely to die of prostate cancer (PC) compared with non-Hispanic white (NHW) men. The authors hypothesized that receiving care through the Veterans Affairs (VA) health system, an equal-access medical system, would attenuate this disparity.

Methods: A longitudinal, centralized database of >20 million veterans was used to assemble a cohort of 60,035 men (18,201 AA men [30.3%] and 41,834 NHW men [69.7%]) who were diagnosed with PC between 2000 and 2015.

Results: AA men were more likely to live in regions with a lower median income ($40,871 for AA men vs $48,125 for NHW men; P < .001) and lower high school graduation rates (83% for AA men vs 88% for NHW men; P < .001). At the time of diagnosis, AA men were younger (median age, 63.0 years vs 66.0 years; P < .001) and had a higher prostate-specific antigen level (median, 6.7 ng/mL vs 6.2 ng/mL; P < .001), but were less likely to have Gleason score 8 to 10 disease (18.8% among AA men vs 19.7% among NHW men; P < .001), a clinical T classification ≥3 (2.2% vs 2.9%; P < .001), or distant metastatic disease (2.7% vs 3.1%; P = 0.01). The 10-year PC-specific mortality rate was slightly lower for AA men (4.4% vs 5.1%; P = .005), which was confirmed in multivariable competing-risk analysis (subdistribution hazard ratio, 0.85; 95% CI, 0.78-0.93; P < .001).

Conclusions: AA men diagnosed with PC in the VA health system do not appear to present with more advanced disease or experience worse outcomes compared with NHW men, in contrast to national trends, suggesting that access to care is an important determinant of racial equity.

Keywords: disparities; health services research; prostate cancer; race; veterans.

PubMed Disclaimer

Comment in

References

    1. Steele CB, Li J, Huang B, Weir HK. Prostate cancer survival in the United States by race and stage (2001-2009): findings from the CONCORD-2 study. Cancer. 2017;123(suppl 24):5160-5177.
    1. Noone AM, Howlader N, Krapcho M, et al, eds. SEER Cancer Statistics Review, 1975-2015. National Cancer Institute; 2018.
    1. Bhardwaj A, Srivastava SK, Khan MA, et al. Racial disparities in prostate cancer: a molecular perspective. Front Biosci (Landmark Ed). 2017;22:772-782.
    1. Odedina FT, Akinremi TO, Chinegwundoh F, et al. Prostate cancer disparities in Black men of African descent: a comparative literature review of prostate cancer burden among Black men in the United States, Caribbean, United Kingdom, and West Africa. Infect Agent Cancer. 2009;4(suppl 1):S2.
    1. Wallace TA, Prueitt RL, Yi M, et al. Tumor immunobiological differences in prostate cancer between African-American and European-American men. Cancer Res. 2008;68:927-936.

Publication types

MeSH terms

Substances

LinkOut - more resources