Insurance Type, Race Tied to Disparities in Prostate Cancer

Men with Medicaid are more likely to present with metastatic prostate cancer than men presenting with prostate cancer who have private insurance, according to a new study, but there are racial disparities in terms of outcomes among those privately insured that are not seen among Medicaid recipients.

“The presence and type of health insurance are key factors that may influence [prostate cancer] outcomes,” wrote study authors led by Amandeep R. Mahal, BS, of Yale University School of Medicine in New Haven, Connecticut. “[I]t is critically important to evaluate the relationship Medicaid (vs private insurance) may have on treatment patterns in the care of patients with prostate cancer.”

The researchers used data from the Surveillance, Epidemiology, and End Results (SEER) database to assess outcomes among 155,524 men younger than 65 years of age who were diagnosed with prostate cancer. The results were published online ahead of print in Cancer.

A total of 108,408 men were white, and 27,529 were African American; another 6,182 were other races. Compared to those with private insurance, men with Medicaid had an adjusted odds ratio (OR) for presenting with metastatic disease of 4.27 (95% CI, 4.01–4.55; P < .001). Men who were uninsured had an adjusted OR of 4.12 (95% CI, 3.80–4.48; P < .001). African American men had an adjusted OR for metastatic disease of 1.07 (95% CI, 1.01–1.13; P = .015) and other races and an OR of 1.13 (95% CI, 1.02–1.25; P = .024).

Among men with localized disease, insurance status and race also were determinants of receiving definitive treatment. Compared to those with private insurance, those with Medicaid were less likely to receive definitive treatment, with an adjusted OR of 0.67 (95% CI, 0.62–0.71; P < .001). African-Americans were also less likely to receive such treatment than white patients, with an adjusted OR of 0.96 (95% CI, 0.93–0.99; P = .03). The same trends were seen with regard to prostate cancer–specific survival.

The study found significant interactions between race and the type of insurance in terms of presentation with metastatic disease, receipt of definitive treatment, and prostate cancer–specific mortality. There were gaps in those outcomes based on race in the privately insured patients, but no such disparities were observed among Medicaid patients.

When the investigators projected out to 100 months of follow-up, the rates of prostate cancer–specific mortality were “much greater” for black men compared with non-black men among those who had private insurance. In contrast, the racial disparities were reduced in Medicaid patients, though there was a trend toward higher such mortality overall.

“More work needs to be done to close the racial gap in [prostate cancer] outcomes for patients with private insurance,” the authors concluded. “Medicaid appears to provide more racially equal prostate cancer outcomes, although efforts need to be made to improve outcomes overall.”