Department of Medicine, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, 19104-2676, USA.
BJU Int. 2010 Sep;106(6):801-8. doi: 10.1111/j.1464-410X.2010.09227.x. Epub 2010 Feb 11.
To analyse the racial and ethnic variation in health resource use (HRU) and direct medical care (DMC) cost in elderly men with prostate cancer.
This was a retrospective case-control study using the linked Surveillance, Epidemiology, and End Results Medicare database. Patients with prostate cancer diagnosed between 1995 and 1998 (50 147 men) were identified and followed retrospectively for 1 year before and 5 years after the diagnosis. Phase-specific HRU and DMC costs were compared between racial and ethnic groups using parametric and nonparametric analysis. To compute the incremental cost of prostate cancer, a matched non-cancer control group was extracted from Medicare database. Poisson and general linear models (log-link) were used to identify the association of race and ethnicity with HRU and DMC cost, after controlling for potentially influential clinical and demographic covariates.
The African-American group was more likely to have emergency-room visits (odds ratio 1.19, 95% confidence interval 1.12-1.28) and less likely to have outpatient visits (0.96, 0.96-0.97) than whites. However, the Hispanic group was more likely to have inpatient and outpatient visits (odds ratio 0.88, 0.83-0.91; and 0.93, 0.91-0.95) than whites. Adjusted DMC cost showed racial and ethnic variation in all phases except the treatment and terminal phases. Factors associated with DMC cost varied among racial and ethnic groups.
The incremental burden of prostate cancer remains significant in the long term. Overall, the cost of prostate cancer care was higher among African-American men than white and Hispanic men. This indicates the need for further research on care-level factors to comprehend the racial and ethnic disparity in HRU and cost.
分析老年男性前列腺癌患者健康资源利用（HRU）和直接医疗费用（DMC）的种族和民族差异。
这是一项回顾性病例对照研究，使用了监测、流行病学和最终结果（SEER）-医疗保险数据库。确定了 1995 年至 1998 年间诊断为前列腺癌的患者（50147 人），并对他们进行了回顾性随访，在诊断前 1 年和诊断后 5 年进行了随访。使用参数和非参数分析比较了不同种族和民族群体之间的阶段性 HRU 和 DMC 费用。为了计算前列腺癌的增量成本，从医疗保险数据库中提取了一个非癌症对照匹配组。使用泊松和广义线性模型（对数链接），在控制了潜在的临床和人口统计学协变量后，确定种族和民族与 HRU 和 DMC 成本的关联。
与白人相比，非裔美国人更有可能因急诊就诊（优势比 1.19，95%置信区间 1.12-1.28），而不太可能因门诊就诊（0.96，0.96-0.97）。然而，与白人相比，西班牙裔更有可能住院和门诊就诊（优势比 0.88，0.83-0.91；和 0.93，0.91-0.95）。除治疗和终末期外，所有阶段的调整后 DMC 成本均显示出种族和民族差异。与 DMC 成本相关的因素在不同种族和民族群体中存在差异。
前列腺癌的增量负担在长期内仍然显著。总体而言，非洲裔美国男性的前列腺癌护理费用高于白人男性和西班牙裔男性。这表明需要进一步研究护理水平因素，以了解 HRU 和成本方面的种族和民族差异。
