Racial Disparity in Outcomes Among Prostate Cancer Patients in the Post-Affordable Care Act Period.

Chhatre S, Malkowicz SB, Gallo JJ, Jayadevappa R. Racial Disparity in Outcomes Among Prostate Cancer Patients in the Post-Affordable Care Act Period. Urology practice. 2023 Mar 1; 10(2):123-129.

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Abstract:

INTRODUCTION: Our objective was to assess whether Medicaid expansion is associated with reduced racial disparity in quality of care measured as 30-day mortality, 90-day mortality, and 30-day readmission in prostate cancer patients receiving surgery. METHODS: We used the National Cancer Database to extract a cohort of African American and White men diagnosed with prostate cancer between 2004 and 2015 and surgically treated. We used 2004-2009 data to observe preexisting racial disparity in outcomes. We used 2010-2015 data to assess racial disparity in outcomes and the interaction of race and Medicaid expansion status. RESULTS: Between 2004 and 2009, 179,762 men met our criteria. In this period, African American patients reported higher hazard of 30- and 90-day mortality and higher odds of 30-day readmission compared to White patients. Between 2010 and 2015, 174,985 men met our criteria. Of these 84% were White and 16% were African American. Main effects models showed that compared to White men, African American men had higher odds of 30-day mortality (OR = 1.96, 95% CI = 1.46, 2.67), 90-day mortality (OR = 1.40, 95% CI = 1.11, 1.77), and 30-day readmission (OR = 1.28, 95% CI = 1.19, 1.38).The interactions between race and Medicaid expansion were not significant ( = .1306, .9499, and .5080, respectively). CONCLUSIONS: Improved access to care via Medicaid expansion may not translate into reduced racial disparity in quality-of-care outcomes in prostate cancer patients treated surgically. System-level factors such as availability of and referrals to care, and complex socioeconomic structure may also play a role in improving quality of care and reducing disparities.