Abstract
Objective
To determine whether patient race/ethnicity are associated with differences in likelihood
of undergoing surgical treatment for LUTS/BPH.
Methods
Queried hospital network database between 1/2011 and 10/2018. Men over age 40 on medical
therapy for LUTS (selective alpha blockade and/or 5-alpha-reductase inhibitor), with
2+ provider visits, and without bladder/prostate malignancy were included. Ethnicity/race
determined by self-identification. Insurance status classified as public (Medicare/Medicaid/Tricare),
private, self-pay, or other.
Multivariable backwards step-wise logistic regression was performed to compare odds
of undergoing a surgical procedure by race/ethnicity, controlling for patient age,
insurance status, comorbidities, and type of medical therapy.
Results
30,466 patients included, with White (n=24,443, 80.2%), Hispanic (n=2,715, 8.9%),
Black (n=1,245, 4.1%), and other race/ethnicity (2,073, 6.8%) identified within the
study population. After adjusting for age, insurance status, major comorbidities,
and type of medical therapy, Black patients were less likely to undergo surgery than
White patients (OR 0.57, 95% CI 0.37 – 0.88, P = .011), as were patients of other race/ethnicity (OR 0.67, 95% CI 0.49 – 0.92, P = .013).
Conclusions
Adjusting for age, insurance status, major comorbidities and type of LUTS medication,
men categorized as Black were significantly less likely to undergo surgical treatment
for LUTS/BPH than White patients. It is unknown whether this difference results from
differences in counseling, access, or other bias in therapy. Efforts to understand
and respond to this disparity are necessary. Limitations include lack of IPSS data,
additional comorbidity data, limited geographic area, and retrospective nature.
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References
Feinstein L, Matlaga B, et.al. Urologic Diseases in America. US Department of Health and Human Services, Public Health Service, NIH, NIDDK. US Government Printing Office, 2018; NIH Publication No. 12-7865
Launer BM, McVary KT, Ricke WA, Lloyd GL. The rising worldwide impact of benign prostatic hyperplasia. BJU Int. doi:10.1111/BJU.15286
- A multicenter randomized noninferiority trial comparing greenlight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study.Eur Urol. 2016; 69: 94-102https://doi.org/10.1016/j.eururo.2015.07.054
- Comparative effectiveness and safety of monodrug therapies for lower urinary tract symptoms associated with benign prostatic hyperplasia.Medicine (Baltimore). 2015; 94: e974https://doi.org/10.1097/MD.0000000000000974
- R: A language and environment for statistical computing.R Found Stat Comput Vienna, Austria2014 (URL http//wwwR-project.org/. 2014:R Foundation for Statistical Computing. doi:/S0103-64402004000300015)
- Racial differences in prostate cancer: does timing of puberty play a role?.Br J Cancer. 2020; : 1-6https://doi.org/10.1038/s41416-020-0897-4
- Prostate cancer genetics: variation by race, ethnicity, and geography.Semin Radiat Oncol. 2017; 27: 3-10https://doi.org/10.1016/J.SEMRADONC.2016.08.002
- Race/ethnicity, obesity, health related behaviors and the risk of symptomatic benign prostatic hyperplasia: results from the prostate cancer prevention trial.J Urol. 2007; 177: 1395-1400https://doi.org/10.1016/j.juro.2006.11.065
- Epidemiology of benign prostatic hyperplasia and comorbidities in racial and ethnic minority populations.Am J Med. 2008; 121https://doi.org/10.1016/j.amjmed.2008.05.021
- Taking race out of human genetics.Science (80-). 2016; 351 (564 LP-565)https://doi.org/10.1126/science.aac4951
- Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review.Am J Public Health. 2015; 105: e60-e76https://doi.org/10.2105/AJPH.2015.302903
- Unconscious (implicit) bias and health disparities: where do we go from here?.Perm J. 2011; 15 (Accessed July 27, 2020): 71-78
- Poll: Most Americans Say They Are Discriminated Against, Regardless Of Race : Shots - Health News : NPR. National PublicRadio.2017 (PublishedAccessed July 6, 2020)
- 40 Years of Human Experimentation in America: The Tuskegee Study | Office for Science and Society.McGill University. McGill University Office for Science and Society, 2019 (PublishedAccessed July 6, 2020)
- Racial/ethnic differences in physician distrust in the United States.Am J Public Health. 2007; 97: 1283-1289https://doi.org/10.2105/AJPH.2005.080762
- Dissecting racial bias in an algorithm used to manage the health of populations.Science (80-). 2019; 366: 447-453https://doi.org/10.1126/SCIENCE.AAX2342
- A systematic review of the food and drug administration's “exception from informed consent” pathway.Health Aff (Millwood). 2018; 37https://doi.org/10.1377/HLTHAFF.2018.0501
- Racial disparities in analgesic use amongst patients presenting to the emergency department for kidney stones in the United States.Am J Emerg Med. 2020; https://doi.org/10.1016/j.ajem.2020.01.017
- Analgesic access for acute abdominal pain in the emergency department among racial/ethnic minority patients: a nationwide examination.Med Care. 2015; 53: 1000-1009https://doi.org/10.1097/MLR.0000000000000444
- Perceived discrimination predicts longer time to be accepted for kidney transplant.Transplantation. 2012; 93: 423-429https://doi.org/10.1097/TP.0b013e318241d0cd
- Racial differences in completion of the living kidney donor evaluation process.Clin Transplant. 2018; 32: e13291https://doi.org/10.1111/ctr.13291
- Health care disparities in urologic oncology: a systematic review.Urology. 2020; 136: 9-18https://doi.org/10.1016/j.urology.2019.09.058
- Racial/ethnic disparity in treatment for prostate cancer: does cancer severity matter?.Urology. 2017; 99: 76-83https://doi.org/10.1016/j.urology.2016.07.045
- Racial/ethnic differences in receipt of pelvic lymph node dissection among men with localized/regional prostate cancer.Cancer. 2011; 117: 4651-4658https://doi.org/10.1002/cncr.26103
- 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: 445-451https://doi.org/10.1016/j.eururo.2017.07.023
- Racial disparities in the treatment of benign prostatic hyperplasia.Med Surg Urol. 2015; 04https://doi.org/10.4172/2168-9857.1000157
- Population Estimates Program.2018 (Washington, DC)
- Meta-analysis and systematic review of intermediate-term follow-up of prostatic urethral lift for benign prostatic hyperplasia.Int Urol Nephrol. 2020; https://doi.org/10.1007/s11255-020-02408-y
- A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update.Eur Urol. 2015; 67: 1066-1096https://doi.org/10.1016/j.eururo.2014.06.017
- Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study.Eur Urol. 2015; 68: 418-425https://doi.org/10.1016/j.eururo.2014.11.006
Article info
Publication history
Published online: July 22, 2021
Accepted:
May 12,
2021
Received:
December 27,
2020
Footnotes
Disclosures: none
Funding: Supported by the Health Data Compass Data Warehouse (www.healthdatacompass.org)
Identification
Copyright
© 2021 Published by Elsevier Inc.
