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• W1976606502 abstract "No AccessJournal of UrologyAdult Urology1 Mar 2012Impact of Distance to a Urologist on Early Diagnosis of Prostate Cancer Among Black and White Patients Jordan A. Holmes, William R. Carpenter, Yang Wu, Laura H. Hendrix, Sharon Peacock, Mark Massing, Anna P. Schenck, Anne-Marie Meyer, Kevin Diao, Stephanie B. Wheeler, Paul A. Godley, Karyn B. Stitzenberg, and Ronald C. Chen Jordan A. HolmesJordan A. Holmes Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , William R. CarpenterWilliam R. Carpenter Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina More articles by this author , Yang WuYang Wu University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina More articles by this author , Laura H. HendrixLaura H. Hendrix Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Sharon PeacockSharon Peacock The Carolinas Center for Medical Excellence, Cary, North Carolina More articles by this author , Mark MassingMark Massing The Carolinas Center for Medical Excellence, Cary, North Carolina More articles by this author , Anna P. SchenckAnna P. Schenck Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina More articles by this author , Anne-Marie MeyerAnne-Marie Meyer University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina More articles by this author , Kevin DiaoKevin Diao Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , Stephanie B. WheelerStephanie B. Wheeler Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina More articles by this author , Paul A. GodleyPaul A. Godley Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina More articles by this author , Karyn B. StitzenbergKaryn B. Stitzenberg Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author , and Ronald C. ChenRonald C. Chen Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.10.156AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We examined whether an increased distance to a urologist is associated with a delayed diagnosis of prostate cancer among black and white patients, as manifested by higher risk disease at diagnosis. Materials and Methods: North Carolina Central Cancer Registry data were linked to Medicare claims for patients with incident prostate cancer diagnosed in 2004 to 2005. Straight-line distances were calculated from the patient home to the nearest urologist. Race stratified multivariate ordinal logistic regression was used to examine the association between distance to a urologist and prostate cancer risk group (low, intermediate, high or very high/metastasis) at diagnosis for black and white patients while accounting for age, comorbidity, marital status and diagnosis year. An overall model was then used to examine the distance × race interaction effect. Results: Included in analysis were 1,720 white and 531 black men. In the overall cohort the high risk cancer rate increased monotonically with distance to a urologist, including 40% for 0 to 10, 45% for 11 to 20 and 57% for greater than 20 miles. Correspondingly the low risk cancer rate decreased with longer distance. On race stratified multivariate analysis longer distance was associated with higher risk prostate cancer for white and black patients (p = 0.04 and <0.01, respectively) but the effect was larger in the latter group. The distance × race interaction term was significant in the overall model (p = 0.03). Conclusions: Longer distance to a urologist may disproportionally impact black patients. Decreasing modifiable barriers to health care access, such as distance to care, may decrease racial disparities in prostate cancer. References 1 : Cancer statistics, 2011: The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin2011; 61: 212. Google Scholar 2 : Determinants of prostate cancer-specific survival after radiation therapy for patients with clinically localized prostate cancer. J Clin Oncol2002; 20: 4567. 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J Clin Oncol2010; 28: 4687. Google Scholar 21 : Racial/ethnic disparities in the treatment of localized/regional prostate cancer. J Urol2004; 171: 1504. Link, Google Scholar 22 : Differences in prognostic factors and survival among white men and black men with prostate cancer, California, 1995–2004. Am J Epidemiol2007; 166: 71. Google Scholar 23 : Race, biochemical disease recurrence, and prostate-specific antigen doubling time after radical prostatectomy: results from the SEARCH database. Cancer2007; 110: 2202. Google Scholar 24 : Differences in socioeconomic status and survival among white and black men with prostate cancer. Am J Epidemiol2000; 151: 409. Google Scholar 25 : Socioeconomic status and prostate cancer incidence and mortality rates among the diverse population of California. Cancer Causes Control2009; 20: 1431. Google Scholar 26 : Racial disparity and socioeconomic status in association with survival in older men with local/regional stage prostate carcinoma: findings from a large community-based cohort. Cancer2006; 106: 1276. Google Scholar 27 : Racial differences in androgen receptor protein expression in men with clinically localized prostate cancer. J Urol2003; 170: 990. Link, Google Scholar 28 : Prostate biopsies from black men express higher levels of aggressive disease biomarkers than prostate biopsies from white men. Prostate Cancer Prostatic Dis2011; 14: 262. Google Scholar © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 3March 2012Page: 883-888 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.Keywordshealthcare disparitiesprostateAfrican Americansprostatic neoplasmshealth services accessibilityMetricsAuthor Information Jordan A. Holmes Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author William R. Carpenter Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina More articles by this author Yang Wu University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina More articles by this author Laura H. Hendrix Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Sharon Peacock The Carolinas Center for Medical Excellence, Cary, North Carolina More articles by this author Mark Massing The Carolinas Center for Medical Excellence, Cary, North Carolina More articles by this author Anna P. Schenck Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina More articles by this author Anne-Marie Meyer University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina More articles by this author Kevin Diao Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Stephanie B. Wheeler Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina More articles by this author Paul A. Godley Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Division of Hematology-Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina More articles by this author Karyn B. Stitzenberg Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina More articles by this author Ronald C. Chen Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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• W1976606502 title "Impact of Distance to a Urologist on Early Diagnosis of Prostate Cancer Among Black and White Patients" @default.
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