Division of Preventive Medicine, University of Alabama, Birmingham, AL 35294-4410, USA.
Med Care. 2010 Oct;48(10):915-22. doi: 10.1097/MLR.0b013e3181eb31a8.
Black prostate cancer patients are less likely to receive aggressive therapy (AT) than Whites: reported rates for patients ≥ 65 years old are about 55% versus 65%. Little is known about treatment rates in socioeconomically deprived states with large Black populations like Alabama.
Medicare claims and Alabama Statewide Cancer Registry records were linked for Alabamian men in Medicare fee-for-service diagnosed with loco-regional prostate cancer in 2000-2002. The association between race and likelihood of: (1) AT (prostatectomy or external beam radiation therapy [EBRT] or brachytherapy); (2) hormone therapy (primary androgen deprivation therapy [ADT] or orchiectomy); (3) <30 days of EBRT; and (4) <6 months of ADT, was investigated adjusting for age, clinical tumor stage, grade, Comorbidity Index, and census tract proportion of Black residents, of persons living below poverty and with ≤ high school.
Of 3561 patients, 71.2% received AT and 38.3% hormone therapy. Blacks were less likely to receive AT (64.3% vs. 73.0%, adjusted [adj.] OR: 0.80, CI: 0.67-0.96). There was no difference between Blacks and Whites in the likelihood of receiving hormone therapy (40.8% vs. 37.7%, adj. OR: 1.10, CI: 0.91-1.34), <30 days of EBRT (30.5% vs. 31.5%, adj. OR: 0.98, CI: 0.72-1.32) or <6 months of ADT (50.7% vs. 54.0%, adj. OR: 0.84, CI: 0.63-1.12).
In Alabama, there were racial differences in utilization of aggressive treatment for locoregional prostate cancer. Research should investigate factors associated with prostate cancer treatment among older men, such as patient behavior and access to care.
黑人前列腺癌患者接受积极治疗（AT）的可能性低于白人：报告称，65 岁以上患者的治疗率约为 55%，而白人患者的治疗率约为 65%。对于像阿拉巴马州这样拥有大量黑人且社会经济落后的州，关于治疗率的信息知之甚少。
将 Medicare 报销记录和阿拉巴马州全州癌症登记处的记录进行了关联，分析了 2000 年至 2002 年期间在 Medicare 按服务收费模式下接受局部区域前列腺癌治疗的阿拉巴马州男性患者。研究分析了种族与以下因素的关联：（1）接受 AT（前列腺切除术或外照射放疗[EBRT]或近距离放射治疗）的可能性；（2）接受激素治疗（原发性雄激素剥夺治疗[ADT]或睾丸切除术）的可能性；（3）接受 EBRT 的时间<30 天；（4）接受 ADT 的时间<6 个月。研究通过调整年龄、临床肿瘤分期、分级、合并症指数、黑人居民在普查区的比例、生活在贫困线以下的人数和高中以下学历人数对上述因素进行了调整。
在 3561 名患者中，71.2%接受了 AT，38.3%接受了激素治疗。黑人患者接受 AT 的可能性较低（64.3% vs. 73.0%，调整后[adj.]OR：0.80，95%CI：0.67-0.96）。黑人患者与白人患者在接受激素治疗的可能性方面没有差异（40.8% vs. 37.7%，adj.OR：1.10，95%CI：0.91-1.34），接受 EBRT 的时间<30 天的可能性（30.5% vs. 31.5%，adj.OR：0.98，95%CI：0.72-1.32）或接受 ADT 的时间<6 个月的可能性（50.7% vs. 54.0%，adj.OR：0.84，95%CI：0.63-1.12）。
在阿拉巴马州，局部区域前列腺癌的积极治疗中存在种族差异。研究应调查与老年男性前列腺癌治疗相关的因素，如患者行为和获得治疗的机会。
