Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA.
Cancer. 2012 Apr 1;118(7):1894-900. doi: 10.1002/cncr.26527. Epub 2011 Sep 6.
Race represents an established barrier to health care access in the United States and elsewhere. We examined whether race affects the utilization rate of minimally invasive radical prostatectomy (MIRP) in a population-based sample of individuals from the United States.
Within the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (NIS), we focused on patients in whom MIRP and open radical prostatectomy (ORP) were performed between 2001 and 2007. We assessed the proportions and temporal trends in race distributions between MIRP and ORP. Multivariable logistic regression analyses further adjusted for age, year of surgery, baseline Charlson Comorbidity Index, annual hospital caseload tertiles, hospital region, insurance status, and median zip code income.
Of 65,148 radical prostatectomies, 3581 (5.5%) were MIRPs. African Americans accounted for 11.4% of patients versus 78.8% for Caucasians versus 9.9% for others. Between 2001 and 2007, the annual proportions of Caucasian patients treated with MIRP were 2.2%, 0.9%, 2.6%, 7.2%, 4.7%, 9.3%, and 11.6%, respectively (chi-square trend p<0.001). For the same years in African American patients, the proportions were 0.8, 0.3, 1.4, 4.4, 3.5, 9.0 and 8.4% (chi-square trend P < .001). In multivariable analyses relative to Caucasian patients, African American patients were 14% less likely to undergo MIRP (P = .01). After period stratification between years 2001-2005 versus 2006-2007, African Americans were 22% less likely to undergo a MIRP in the early period (P = .007) versus 11% less likely to have a MIRP in the contemporary period (P = .1).
The racial discrepancies in MIRP utilization rates are gradually improving.
在美国和其他国家，种族是获得医疗保健的既定障碍。我们研究了在来自美国的人群基础样本中，种族是否会影响微创根治性前列腺切除术（MIRP）的利用率。
在医疗保健成本和利用项目全国住院患者样本（NIS）中，我们关注于 2001 年至 2007 年间接受 MIRP 和开放性根治性前列腺切除术（ORP）的患者。我们评估了 MIRP 和 ORP 之间种族分布的比例和时间趋势。多变量逻辑回归分析进一步调整了年龄、手术年份、基线 Charlson 合并症指数、医院年病例量 tertiles、医院区域、保险状况和中位数邮政编码收入。
在 65148 例根治性前列腺切除术患者中，有 3581 例（5.5%）接受了 MIRP。非裔美国人占患者的 11.4%，白种人占 78.8%，其他人占 9.9%。在 2001 年至 2007 年间，每年接受 MIRP 治疗的白种人患者比例分别为 2.2%、0.9%、2.6%、7.2%、4.7%、9.3%和 11.6%（卡方趋势 P<0.001）。在同样的几年中，非裔美国人患者的比例分别为 0.8%、0.3%、1.4%、4.4%、3.5%、9.0%和 8.4%（卡方趋势 P <.001）。在多变量分析中，与白种人患者相比，非裔美国人患者接受 MIRP 的可能性低 14%（P=0.01）。在 2001-2005 年与 2006-2007 年期间进行的时期分层后，非裔美国人在早期接受 MIRP 的可能性低 22%（P=0.007），而在当代接受 MIRP 的可能性低 11%（P=0.1）。
MIRP 利用率的种族差异正在逐渐改善。
