Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD 21287, USA.
Med Care. 2011 Nov;49(11):999-1006. doi: 10.1097/MLR.0b013e3182364019.
Patients who receive surgery from high-volume surgeons tend to have better outcomes. Black patients, however, are less likely to receive surgery from high-volume surgeons.
Among men with localized prostate cancer, we examined whether disparities in use of high-volume urologists resulted from racial differences in patients being diagnosed by high-volume urologists and/or changing to high-volume urologists for surgery.
Retrospective cohort study from Surveillance, Epidemiology, and End Results-Medicare data.
A total of 26,058 black and white men in Surveillance, Epidemiology, and End Results-Medicare diagnosed with localized prostate cancer from 1995 to 2005 that underwent prostatectomy. Patients were linked to their diagnosing urologist and a treating urologist (who performed the surgery).
Diagnosis and receipt of prostatectomy by a high-volume urologist, and changing between diagnosing and treating urologist
After adjustment for confounders, black men were as likely as white men to be diagnosed by a high-volume urologist; however, they were significantly less likely than white men to be treated by a high-volume urologist [odds ratio 0.76; 95% confidence interval (CI), 0.67-0.87]. For men diagnosed by a low-volume urologist, 46.0% changed urologists for their surgery. Black men were significantly less likely to change to a high-volume urologist (relative risk ratio 0.61; 95% CI, 0.47-0.79). Racial differences appeared to reflect black and white patients being diagnosed by different urologists and having different rates of changing after being diagnosed by the same urologists.
Lower rates of changing to high-volume urologists for surgery among black men contribute to racial disparities in treatment by high-volume surgeons.
接受高手术量外科医生手术的患者往往有更好的治疗效果。然而，黑人患者接受高手术量外科医生手术的可能性较低。
在患有局限性前列腺癌的男性中，我们研究了是否由于高手术量泌尿科医生对黑人患者的诊断差异以及黑人患者因手术而改变为高手术量泌尿科医生的差异，导致了高手术量泌尿科医生使用方面的差异。
来自监测、流行病学和最终结果-医疗保险数据的回顾性队列研究。
1995 年至 2005 年间，监测、流行病学和最终结果-医疗保险数据库中诊断为局限性前列腺癌的 26058 名黑人和白人男性，他们接受了前列腺切除术。患者与他们的诊断泌尿科医生和治疗泌尿科医生（进行手术的医生）进行了关联。
高手术量泌尿科医生的诊断和接受前列腺切除术，以及在诊断和治疗泌尿科医生之间的转变。
在调整了混杂因素后，黑人男性被高手术量泌尿科医生诊断的可能性与白人男性相同；然而，他们接受高手术量泌尿科医生治疗的可能性明显低于白人男性[优势比 0.76；95%置信区间（CI），0.67-0.87]。对于被低手术量泌尿科医生诊断的男性，46.0%在手术时更换了泌尿科医生。黑人男性更换为高手术量泌尿科医生的可能性明显较低（相对风险比 0.61；95%CI，0.47-0.79）。种族差异似乎反映了黑人患者和白人患者由不同的泌尿科医生诊断，并且在由同一泌尿科医生诊断后，他们改变的比率也不同。
黑人男性在手术时更换为高手术量泌尿科医生的比率较低，导致了黑人患者接受高手术量外科医生治疗的种族差异。
