Black individuals are less likely to be treated for prostate cancer even though they are more than twice as likely to die compared to White individuals. The complex causes of these inequities are influenced by social and structural factors, including racism, which contribute to the differential delivery of care. This study investigates how factors related to the location of where individuals live and receive care affect treatment inequities for prostate cancer between Black and White individuals. We hypothesize that both location and race independently influence treatment inequities. We used data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare claims to estimate the treatment inequity, as defined by differences in radiation or radical prostatectomy. Fixed effects at the physician, hospital, and patient ZIP code levels were incorporated to adjust for all time-invariant factors at these levels. The results indicate that residential location-related factors explain only half of the treatment inequity, while provider- and hospital-level factors do not significantly account for disparities. Even after accounting for all time-invariant factors, significant differences in treatment rates persist. The study highlights the importance of understanding race as a social construct and racism as a systemic and structural phenomenon in addressing treatment inequities. These findings provide a necessary step toward understanding equitable care and designing interventions to solve this inequity.
Journal of the National Cancer Institute. 2024 Nov 20 [Epub ahead of print]
Noah Hammarlund, Sarah K Holt, Ruth Etzioni, Danté Morehead, Jenney R Lee, Erika M Wolff, Yohali Burrola-Mendez, Liz Sage, John L Gore, Yaw A Nyame
Department of Health Services Research Management & Policy, University of Florida, Gainesville, FL, USA., Department of Urology, University of Washington Medical Center, Seattle WA, USA., Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA., Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA.