Differences in Healthcare Expenditures, Visits, and Prescriptions by Race for Common Benign Urologic Conditions



      To identify differences in healthcare expenditures and utilization by race in patients treated for common benign urologic conditions.

      Materials and Methods

      A retrospective secondary data analysis was conducted of patients with common benign urologic conditions using 2016-2018 Medical Expenditure Panel Survey data. Benign conditions included urolithiasis, cystitis, erectile dysfunction (ED), pelvic organ prolapse (POP), urinary incontinence (UI), and benign prostatic hyperplasia (BPH). Generalized linear models were used to evaluate the relationship between total healthcare expenditures and utilization and race for each condition. Adjusted analyses accounted for age, sex, number of chronic conditions, poverty status, self-reported health status, marital status, highest degree of educational attainment, and insurance status.


      The weighted analysis sample consisted of 27,110,416 patients, of whom 80.9% were Non-Hispanic white, 6.9% Non-Hispanic black, and 12.2% other minority races. After adjustment, total healthcare expenditures were significantly lower for Non-Hispanic blacks (incidence rate ratio [IRR] = 0.19, 95% confidence interval [CI]: 0.06-0.61) and other minority races (IRR = 0.30, 95% CI: 0.10-0.88) compared to Non-Hispanic whites treated for ED. Similarly, compared to Non-Hispanic whites, healthcare expenditures were significantly lower for Non-Hispanic blacks treated for UI (IRR = 0.56, 95% CI: 0.35-0.90).


      Healthcare expenditures are significantly lower for Non-Hispanic black patients treated for ED and UI in the US Future research is needed to determine if these differences represent an inequality in the delivery of urologic care for patients with these conditions.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mead H
        • Cartwright-Smith L
        • Jones K
        • Ramos C
        • Woods K
        • Siegel B.
        Racial and Ethnic Disparities in U.S. Healthcare: A Chartbook.
        2008 (Accessed March 15, 2021)
        • Egede LE.
        Race, ethnicity, culture, and disparities in health care.
        J Gen Intern Med. 2006; 21: 667-669
        • Das H
        • Rodriguez R.
        Health care disparities in urologic oncology: a systematic review.
        Urology. 2020; 136: 9-18
        • Klein JB
        • Nguyen CT
        • Saffore L
        • Modlin 3rd, C
        • Modlin Jr., CS
        Racial disparities in urologic health care.
        J Natl Med Assoc. 2010; 102: 108-117
        • Dess RT
        • Hartman HE
        • Mahal BA
        • et al.
        Association of black race with prostate cancer–specific and other-cause mortality.
        JAMA Oncol. 2019; 5: 975-983
        • Friedlander DF
        • Trinh QD
        • Krasnova A
        • et al.
        Racial disparity in delivering definitive therapy for intermediate/high-risk localized prostate cancer: the impact of facility features and socioeconomic characteristics.
        Eur Urol. 2018; 73: 445-451
      1. Cancer ZTEoP. African Americans and prostate cancer. Available at: 2021. Accessed March 15, 2021.

        • Collins M.
        Increasing prostate cancer awareness in African American men.
        Oncol Nurs Forum. 1997; 24: 91-95
        • Miller DC
        • Saigal CS
        • Litwin MS.
        The demographic burden of urologic diseases in America.
        Urol Clin North Am. 2009; 36 (11-v)
        • Cohen JW
        • Cohen SB
        • Banthin JS.
        The medical expenditure panel survey: a national information resource to support healthcare cost research and inform policy and practice.
        Med Care. 2009; 47: S44-S50
        • Association WM.
        World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.
        JAMA. 2013; 310: 2191-2194
        • Spector AL
        • Nagavally S
        • Dawson AZ
        • Walker RJ
        • Egede LE.
        Examining racial and ethnic trends and differences in annual healthcare expenditures among a nationally representative sample of adults with arthritis from 2008 to 2016.
        BMC Health Serv Res. 2020; 20: 531
        • Charron-Chénier R
        • Mueller CW.
        Racial disparities in medical spending: healthcare expenditures for black and white households (2013–2015).
        Race Soc Problems. 2018; 10: 113-133
        • Franks P
        • Fiscella K
        • Meldrum S.
        Racial disparities in the content of primary care office visits.
        J Gen Intern Med. 2005; 20: 599-603
        • Rogers AT
        • Semenov YR
        • Kwatra SG
        • Okoye GA.
        Racial disparities in the management of acne: evidence from the National Ambulatory Medical Care Survey, 2005–2014.
        J Dermatol Treat. 2018; 29: 287-289
        • Smith JF
        • Caan BJ
        • Sternfeld B
        • et al.
        Racial disparities in erectile dysfunction among participants in the California men's health study.
        J Sex Med. 2009; 6: 3433-3439
        • Anger JT
        • Rodríguez LV
        • Wang Q
        • Chen E
        • Pashos CL
        • Litwin MS.
        Racial disparities in the surgical management of stress incontinence among female Medicare beneficiaries.
        J Urol. 2007; 177: 1846-1850
        • Gupta S
        • Ding L
        • Granieri M
        • Le NB
        • Peterson AC.
        Utilization of surgical procedures and racial disparity in the treatment of urinary incontinence after prostatectomy.
        Neurourol Urodyn. 2016; 35: 733-737
        • Briesacher B
        • Limcangco R
        • Gaskin D.
        Racial and ethnic disparities in prescription coverage and medication use.
        Health Care Financ Rev. 2003; 25: 63-76
        • O'Neil SS
        • Lake T
        • Merrill A
        • Wilson A
        • Mann DA
        • Bartnyska LM.
        Racial disparities in hospitalizations for ambulatory care–sensitive conditions.
        Am J Prevent Med. 2010; 38: 381-388
      2. Hostetter, M. & Klein, S. The Commonwealth Foundation. Understanding and ameliorating medical mistrust among black Americans. 2021. Available at:,it's%20worse%20among%20Black%20Americans.&text=In%20an%20October%202020%20poll,prevent%20people%20from%20getting%20care. Accessed June 2, 2021.