Equal-Access Healthcare Is Associated with Significantly Improved Clinical Outcomes in Black and Hispanic Veterans with Prostate Cancer
BACKGROUND:
Racial and ethnic disparities in prostate cancer have been widely observed but are poorly understood. Any given disparity-related factor may affect outcomes differently along the disease’s highly variable trajectory. Black men are more than twice as likely to die of prostate cancer-related causes than White men, and mortality rates among Black men treated for prostate cancer remain higher than in men of other races. This study examined clinical outcomes by race and ethnicity in Veterans with nonmetastatic castration-resistant prostate cancer (nmCRPC). Researchers analyzed the electronic health records of 12,992 VA patients diagnosed with prostate cancer from January 2006 to December 2020, whose cancer progressed to nmCRPC defined by increasing prostate-specific antigen levels, ongoing androgen deprivation, and no evidence of metastatic disease. Veterans with metastatic disease or death within the landmark period (three months after the first nmCRPC evidence) were excluded. Among the cohort members, 826 Veterans identified as Hispanic, 3,671 as non-Hispanic Black (“Black”), 7,323 as non-Hispanic White (“White”), and 1,172 of other race and ethnicity (“other”). The primary outcome was time from the landmark period to death or metastasis; the secondary outcome was overall survival.
FINDINGS:
- Among patients with nmCRPC in VA—an equal-access system—self-identified Black and Hispanic men had better clinical outcomes than White or other patients, including time to metastasis and overall survival.
- Median time elapsed from nmCRPC to metastasis or death was 5.96 years for Black Veterans, 5.62 years for Hispanic Veterans, 4.11 years for White Veterans, and 3.59 years for other Veterans.
- Median unadjusted overall survival was 6.26 years among all Veterans, 8.36 years for Black Veterans, 8.56 years for Hispanic Veterans, 5.48 years for White Veterans, and 4.48 years for other Veterans.
IMPLICATIONS:
- Findings provide evidence that the racial and ethnic disparities long observed in prostate cancer might stem from systemic socioeconomic inequity rather than molecular or genetic factors.
- Black and Hispanic men may have considerably improved outcomes when treated in an equal-access setting.
LIMITATIONS:
- There could be patients who were diagnosed but unaccounted for in this study.
- Data and analysis were restricted to the data available in electronic health records.
AUTHOR/FUNDING INFORMATION:
Dr. Halwani is part of HSR&D’s Informatics, Decision-Enhancement and Analytic Sciences Center in Salt Lake City, UT.
Rasmussen KM, Patil V, Li C, Yong C, Appukkutan S, Partridge Grossman J, Jhaveri J, Halwani AS. Survival Outcomes by Race and Ethnicity in Veterans with Nonmetastatic Castration-Resistant Prostate Cancer. JAMA Network Open. October 11, 2023;6(10):e2337272.
