Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA.
J Urol. 2012 Mar;187(3):883-8. doi: 10.1016/j.juro.2011.10.156. Epub 2012 Jan 15.
We examined whether an increased distance to a urologist is associated with a delayed diagnosis of prostate cancer among black and white patients, as manifested by higher risk disease at diagnosis.
North Carolina Central Cancer Registry data were linked to Medicare claims for patients with incident prostate cancer diagnosed in 2004 to 2005. Straight-line distances were calculated from the patient home to the nearest urologist. Race stratified multivariate ordinal logistic regression was used to examine the association between distance to a urologist and prostate cancer risk group (low, intermediate, high or very high/metastasis) at diagnosis for black and white patients while accounting for age, comorbidity, marital status and diagnosis year. An overall model was then used to examine the distance × race interaction effect.
Included in analysis were 1,720 white and 531 black men. In the overall cohort the high risk cancer rate increased monotonically with distance to a urologist, including 40% for 0 to 10, 45% for 11 to 20 and 57% for greater than 20 miles. Correspondingly the low risk cancer rate decreased with longer distance. On race stratified multivariate analysis longer distance was associated with higher risk prostate cancer for white and black patients (p = 0.04 and <0.01, respectively) but the effect was larger in the latter group. The distance × race interaction term was significant in the overall model (p = 0.03).
Longer distance to a urologist may disproportionally impact black patients. Decreasing modifiable barriers to health care access, such as distance to care, may decrease racial disparities in prostate cancer.
我们研究了距离泌尿科医生的距离增加是否与黑人和白人患者前列腺癌诊断延迟有关，表现为诊断时更高的风险疾病。
北卡罗来纳中央癌症登记处的数据与 2004 年至 2005 年诊断患有前列腺癌的患者的医疗保险索赔相关联。从患者家到最近泌尿科医生的直线距离进行了计算。使用种族分层多变量有序逻辑回归来检查距离泌尿科医生的距离与黑人和白人患者诊断时前列腺癌风险组（低、中、高或非常高/转移）之间的关联，同时考虑年龄、合并症、婚姻状况和诊断年份。然后使用总体模型检查距离×种族相互作用效应。
分析包括 1720 名白人男性和 531 名黑人男性。在整个队列中，高危癌症率随着距离泌尿科医生的距离而单调增加，包括 0 到 10 英里的 40%、11 到 20 英里的 45%和大于 20 英里的 57%。相应地，低危癌症率随着距离的增加而降低。在种族分层多变量分析中，距离较长与白人（p=0.04）和黑人患者（p=0.01）的高危前列腺癌相关，但在后一组中影响更大。距离×种族交互项在总体模型中具有统计学意义（p=0.03）。
距离泌尿科医生的距离较长可能会不成比例地影响黑人患者。减少可改变的医疗保健获取障碍，如距离护理，可以减少前列腺癌的种族差异。
