Health Disparities in Non-Metastatic Prostate Cancer Patients Within the VHA

Health disparities in the US are evident and can be attributed to various factors, including discrimination, adverse social determinants of health, and structural inequalities. Historically marginalized groups face obstacles to equitable health care, such as limited access to insurance and culturally appropriate care. Additionally, disparities in clinical and genetic markers persist due to underrepresentation in clinical trials. In a study published in JAMA Network Open, researchers focus on these disparities in patients with non-metastatic castration-resistant prostate cancer (nmCRPC) in the Veterans Health Administration (VHA).

The VHA is an equal-access health care system that aims to mitigate health care disparities. While some studies within the VHA have reported disparities in diagnosis, treatment, and outcomes, others have found no such disparities. However, most of these studies have focused on survival from time of diagnosis, emphasizing the need to examine disparities at different disease stages.

Prostate cancer is a common disease among men in the US, and racial and ethnic disparities in its diagnosis and outcomes are poorly understood. Black men are more likely to die from prostate cancer, even when controlling for various factors. The reasons for these disparities are complex, involving genetic, environmental, and psychological factors.

Prostate cancer is a highly variable disease, with patient outcomes depending on the disease stage and biological characteristics. As a result, disparities may affect patients at different stages of the disease. Researchers encourage health experts not solely to focus on diagnosis but also examine disparities at various milestones in the disease's progression.

The retrospective observational cohort study in the VHA assessed outcomes for patients with nmCRPC. The study included 12,992 patients, with variations in demographic characteristics by race and ethnicity. Black and Hispanic patients had a reduced risk of metastasis or death compared to White patients, even after adjusting for age and disease severity. These findings suggest that disparities in prostate cancer outcomes may be driven by systemic socioeconomic inequities rather than solely genetic or molecular factors.

"Our findings provide evidence that the racial and ethnic disparities long observed in PC may arise from systemic socioeconomic inequity rather than molecular or genetic factors," said researchers.

Reference

Rasmussen KM, Patil V, Li C, et al. Survival outcomes by race and ethnicity in veterans with nonmetastatic castration-resistant prostate cancer. JAMA Network Open. 2023;6(10):e2337272. doi:10.1001/jamanetworkopen.2023.37272