203281 Racial and Ethnic Disparity in Quality of Care among Elderly Prostate Cancer Patients

Tuesday, November 10, 2009: 1:00 PM

Ravi Jayadevappa, PhD , Department of Medicine, University of Pennsylvania, Philadelphia, PA
Sumedha Chhatre, PhD , Center for Mental Health Policy Services Research, University of Pennsylvnia, Philadelphia, PA
Joseph Gallo , Department of Family Practice and Community Medicine, University of Penssylvania, Philadelphia, PA
S. Bruce Malkowicz, MD , Surgery, University of pennsylvania, Philadelphia, PA
(a) Objective: To analyze the racial and disparity in quality of care among prostate cancer (PCa) patients after controlling for stage, comorbidity socioeconomic status (SES) and clinical characteristics.

(b) Methods: We developed a retrospective case control design using SEER-Medicare databases. Prostate cancer patients diagnosed between 1995 and 1998 were identified and retrospectively followed for one year pre and five years post diagnosis. Following outcomes were used to measure quality care: (1) time to treatment, (2) 30 day postoperative mortality; (3) Number of readmission within 6 months of index admission; (4) Overall survival rate in five year post-treatment; (5) PCa-specific mortality; and (6) Number of ER admissions within 30 days of treatment. Parametric and non-parametric analyses were used to compare quality of care across racial and ethnic groups. Poisson regression (with zero inflation correction) and Cox survival models were used to assess the association between quality of care outcomes and race, after adjusting for Elixahuser comorbidity, SES and stage.

(c) Results: We identified 40,876 Caucasian, 5,867 African American and 3,034 Hispanic men newly diagnosed for PCa between 1995 and 1998. African Americans showed higher mean time to treatment compared to Caucasian and Hispanic men (134, 99 and 89 days respectively, p<.0001). Quality of care measures (ER visits, readmissions, length of stay and mortality) showed significant variation across racial and ethnic groups. Poisson regression indicated that African American group was associated with higher odds of ER and inpatient visits (OR=1.06, p=0.0006 and OR=1.3, p<.0001, respectively). Hispanic group had lower odds of such visits (OR=0.85, p<.0001 and OR=0.87, p=0.004, respectively). Cox survival analysis for mortality indicated higher hazard associated with African American group (HR=1.124, p <.0001) after controlling for demographic and clinical covariates.

(d) Conclusions: African American ethnicity was associated with poorer quality of care as indicated by various quality of care measures.

Learning Objectives:
Analyze the racial and disparity in quality of care among prostate cancer (PCa) patients after controlling for stage, comorbidity socioeconomic status (SES) and clinical characteristics.

Keywords: Cancer, Health Care Quality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Jayadevappa received his doctorate in Public Policy and Management from the University of Pennsylvania in 1996. As of January 1998, he was appointed to the faculty of School of Medicine, Geriatric Division as a Research Associate and was promoted to Research Assistant professor in February 2002. He is also currently a member of the Abramson Cancer center, Senior Fellow at the Leonard Davis Institute of Health Economics, and Fellow at the Institute of Aging, University of Pennsylvania. His career progress in these few years has been extremely productive and impressive. He has embarked on a research career in quality of life and cost of care, minority health issues and economic analysis of Medicare elderly population, with a focus on economic and decision analysis of cancer. He has successfully collaborated with faculty from the Division of Geriatric Medicine, Urology Division, Abramson Cancer Center, Leonard Davis Institute of Health Economics and the Center for Mental Health Policy and Services Research. His primary areas of research interest are regulatory economics, resource economics, health care economics, quality of life, health care disparity, aging and compressed morbidity. In particular, his research goal is to analyze the tradeoff between economic efficiency, equity and quality. This has significant impact in understanding and elimination of health disparities due to race, ethnicity, income, or age. Dr. Jayadevappa’s current research focus is on health services research related to micro/macro level health policy issues of elderly; epidemiology of chronic diseases; and cost-effectiveness of medical care. It is thus logical that several of his ongoing projects are directly related to health services research, especially research related to chronic diseases such as congestive heart failure, prostate cancer, bladder cancer, obesity, breast cancer and Alzheimer’s. Since his appointment as a Research Assistant Professor, Dr. Jayadevappa has established a track record of publications in the Journal of American Geriatrics Society, CANCER, Journal of Urology, Urologic Oncology, British Journal of Urology-International, PharmacoEconomics, Gastroentoerology, British Cancer Journal, Academic Medicine and Ecological Economics.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.