Medicaid not reducing racial disparity in PCa outcomes
African-Americans fare poorly whether on private insurance, Medicaid
African-American men were more likely to present with metastases, less likely to receive definitive therapy, and had increased prostate cancer-specific mortality compared with non-African-American men regardless of whether they were privately insured or insured through Medicaid, a study presented at the Genitourinary Cancers Symposium in Orlando, FL found.
“Given that disparities for prostate cancer still exist among the heterogeneous privately insured cohort, closing the gap in outcomes may likely be achieved by giving equal access to high-quality health insurance,” said Amandeep R. Mahal, of Yale School of Medicine, New Haven, CT, who presented the results. “This may lead to more equal treatment patterns for all patients with aggressive cancers.”
Under the Affordable Care Act, Medicaid expanded health care coverage to those previously uninsured—a patient population largely comprised of minorities and/or patients from counties of lower household incomes and education levels—and this expansion has been hypothesized to reduce racial and socioeconomic inequality in health care, Mahal explained.
In this study, the authors sought to examine whether there was an association between private insurance compared with Medicaid, race, and outcomes for the treatment of high-risk prostate cancer among this population. The study used data taken from the Surveillance, Epidemiology, and End Results Program on 116,853 men aged younger than 65 years diagnosed with prostate cancer between 2007 and 2011. The primary outcomes were presentation with metastatic disease, use of definitive therapy, and prostate cancer-specific mortality.
“After adjusting for appropriate covariates, our results demonstrate that African-American men with prostate cancer are more likely to present with metastatic disease, less likely to be treated definitively, and more likely to die from their cancer than non-black men—results consistent with other findings in the literature that have been persistent over time. These disparities are observed in heterogeneous privately insured cohorts; however, among men with Medicaid, outcomes were equally worse,” Mahal told Urology Times. Mahal worked on the study with James B. Yu, MD, and co-authors.
Compared with men with private insurance, those men with Medicaid were five times more likely to present with metastatic disease (odds ratio: 5.79; 95% CI: 5.25-6.40; p<.001). Among men with high-risk disease, men with Medicaid were significantly less likely to receive definitive therapy (p<.001) and had increased prostate cancer-specific mortality (p<.001).