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. 2024 Feb 29;5(6):564-575.
doi: 10.1002/bco2.342. eCollection 2024 Jun.

Racial and socioeconomic disparities in surgical care for post-prostate cancer treatment complications: A nationwide Medicare-based analysis

Oluwafolajimi Adesanya  1 , Sirikan Rojanasarot  2 , Alysha M McGovern  2 , Arthur L Burnett  1
Affiliations

Racial and socioeconomic disparities in surgical care for post-prostate cancer treatment complications: A nationwide Medicare-based analysis

Oluwafolajimi Adesanya et al. BJUI Compass. .

Erratum in

  • Erratum.
    [No authors listed] [No authors listed] BJUI Compass. 2024 Dec 30;5(12):1324-1329. doi: 10.1002/bco2.482. eCollection 2024 Dec. BJUI Compass. 2024. PMID: 39744071 Free PMC article.

Abstract

Objectives: To investigate the racial and socioeconomic (income) differences in receipt of and time to surgical care for urinary incontinence (UI) and erectile dysfunction (ED) occurring post-radical prostatectomy (RP) and/or radiation therapy (RT).

Materials and methods: Utilizing the Medicare Standard Analytical Files (SAF), a retrospective cohort study was performed on data of patients diagnosed with prostate cancer (PCa) from 2015 to 2021. Patients who underwent RP and/or RT and who subsequently developed UI and/or ED were grouped into four cohorts: RP-ED, RP-UI, RT-ED and RT-UI. County-level median household income was cross-referenced with SAF county codes, classified into income quartiles, and used as a proxy for patient income status. The rate of surgical care was compared between groups using two-sample t-test and log-rank test. Cox proportional hazards modelling was used to determine covariate-adjusted impact of race on time to surgical care.

Results: The rate of surgical care was 6.8, 3.61 3.07, and 1.54 per 100 person-years for the RP-UI, RT-UI, RP-ED, and RT-ED cohorts, respectively. Cox proportional 'time-to-surgical care' regression analysis revealed that Black men were statistically more likely to receive ED surgical care (RP-ED AHR:1.79, 95% CI:1.49-2.17; RT-ED AHR:1.50, 95% CI:1.11-2.01), but less likely to receive UI surgical care (RP-UI AHR:0.80, 95% CI:0.67-0.96) than White men, in all cohorts except RT-UI. Surgical care was highest among Q1 (lowest income quartile) patients in all cohorts except RT-UI.

Conclusions: Surgical care for post-PCa treatment complications is low, and significantly impacted by racial and socioeconomic (income) differences. Prospective studies investigating the basis of these results would be insightful.

Keywords: erectile dysfunction; healthcare disparities; prostate cancer; prostatectomy; urinary incontinence.

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Conflict of interest statement

Support for this research was provided by Boston Scientific, Marlborough, MA. Sirikan Rojanasarot and Alysha McGovern are full‐time employees of Boston Scientific. Oluwafolajimi Adesanya has no conflicts of interest to disclose. Arthur Burnett is a research award recipient from Boston Scientific. Oluwafolajimi Adesanya and Arthur Burnett were not compensated for their participation in this study.

Figures

FIGURE 1
FIGURE 1
Cohort attrition flowcharts. (A) Radiation Therapy‐Erectile Dysfunction (RT‐ED) and Radical Prostatectomy‐Erectile dysfunction (RP‐ED) cohort attrition flowcharts, and (B) Radiation Therapy‐Urinary Incontinence (RT‐UI) and Radical Prostatectomy‐Urinary Incontinence (RP‐UI) cohort attrition flowchart.
FIGURE 2
FIGURE 2
Kaplan–Meier (KM) survival plot of Cox proportional‐hazard regression model. (A) Radical Prostatectomy‐Urinary Incontinence (RP‐UI) cohort KM plot, (B) Radical Prostatectomy‐Erectile Dysfunction (RP‐ED) cohort KM plot, (C) Radiation Therapy‐Urinary Incontinence (RT‐UI) cohort KM plot and (D) Radiation Therapy‐Erectile Dysfunction (RT‐ED) cohort KM plot.
See this image and copyright information in PMC

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