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racial disparity, urology

Daniel C Parker, Elizabeth Handorf, Marc C Smaldone, Robert G Uzzo, Henry Pitt, Adam C Reese
PURPOSE: Racial disparities in complication rates have been demonstrated for a variety of surgical procedures. We hypothesized that African American (AA) patients experience higher postoperative complication rates than whites following urologic oncology procedures. MATERIALS AND METHODS: Patients in American College of Surgeons National Surgical Quality Improvement Program who underwent radical prostatectomy (RP), radical or partial nephrectomy (RN/PN), and radical cystectomy (RC) between 2005 and 2013 were included...
August 31, 2017: Urologic Oncology
Michelle S Wong, David T Grande, Nandita Mitra, Archana Radhakrishnan, Charles C Branas, Katelyn R Ward, Craig E Pollack
BACKGROUND: Geographic access-the travel burden required to reach medical care-is an important aspect of care. Studies, which typically rely on geographic information system (GIS) calculated travel times, have found some evidence of racial disparities in spatial access to care. However, the validity of these studies depends on the accuracy of travel times by patient race. OBJECTIVES: To determine if there are racial differences when comparing patient-reported and GIS-calculated travel times...
September 2017: Medical Care
Craig Evan Pollack, Katrina A Armstrong, Nandita Mitra, Xinwei Chen, Katelyn R Ward, Archana Radhakrishnan, Michelle S Wong, Justin E Bekelman, Charles C Branas, Karin V Rhodes, David T Grande
BACKGROUND: Racial disparities in prostate cancer treatment and outcomes are widespread and poorly understood. In the current study, the authors sought to determine whether access to care, measured across multiple dimensions, contributed to racial differences in prostate cancer. METHODS: The Philadelphia Area Prostate Cancer Access Study (P2 Access) included 2374 men diagnosed with localized prostate cancer between 2012 and 2014. Men were surveyed to assess their experiences accessing care (response rate of 51...
November 15, 2017: Cancer
Jathin Bandari, Charles B Wessel, Bruce L Jacobs
PURPOSE OF REVIEW: Comparative effectiveness research plays a vital role in healthcare delivery by guiding evidence-based practices. We performed a state-of-the-art review of comparative effectiveness research in the urology literature for 2016, utilizing a systematic approach. Seven high-impact papers are reviewed in detail. RECENT FINDINGS: Across the breadth of urology, there were several important studies in comparative effectiveness research, of which we will highlight two randomized controlled trials and five observational trials: radiotherapy, prostatectomy, and active monitoring have equivalent mortality outcomes in patients with localized prostate cancer; the ideal modality of patient education is yet to be determined, and written education has minimal effect on patient perception of prostate specific antigen screening; robotic prostatectomy is associated with higher perioperative complication rates on a population basis; racial disparities exist in incontinence rates after treatment for localized prostate cancer, but not in irritative, bowel, or sexual function; androgen deprivation therapy is associated with higher fracture, peripheral artery disease, and cardiac-related complications than bilateral orchiectomy; robotic and open cystectomy offer comparable cancer-specific mortality and perioperative outcomes; and bonuses for low-cost hospitals can inadvertently reward low-quality hospitals...
July 2017: Current Opinion in Urology
Kyo Chul Koo, Kwang Suk Lee, Byung Ha Chung
The incidence and prevalence of prostate and kidney cancers have been increasing in Korea during the last decade, and a marked improvement in survival rates has been noted. With a substantial proportion of the cancers diagnosed at an earlier stage of the disease, the landscape of urologic cancer treatment in Korea has been characterized by an exponential increase in the number of patients receiving surgical treatment. Throughout the last decade, an increasing proportion of surgeries have been performed using minimally invasive methods, with a notable increase in robot-assisted surgery...
September 2015: Japanese Journal of Clinical Oncology
Aruna V Sarma, Jennifer L St Sauver, Debra J Jacobson, Michaela E McGree, George G Klee, Michael M Lieber, Cynthia J Girman, John M Hollingsworth, Steven J Jacobsen
OBJECTIVE: To determine the distribution of, and racial differences in, changes in prostate-specific antigen (PSA) from a population-based sample of men. MATERIALS AND METHODS: Data from 2 prospective cohort studies of a random sample of white men, aged 40-79 years in 1990, followed biennially through 2007, and African American men, aged 40-79 years in 1996, followed through 2000, were examined to assess the longitudinal changes in PSA concentrations. Serum PSA levels were determined at each examination for both cohorts and observations after a diagnosis of prostate cancer or treatment of benign prostatic hyperplasia were censored...
January 2014: Urology
Rebecca S Piccolo, Andre B Araujo, Neil Pearce, John B McKinlay
The Boston Area Community Health (BACH) Survey is a community-based, random sample, epidemiologic cohort of n = 5502 Boston (MA) residents. The baseline BACH Survey (2002-05) was designed to explore the mechanisms conferring increased health risks on minority populations with a particular focus on urologic signs/symptoms and type 2 diabetes. To this end, the cohort was designed to include adequate numbers of US racial/ethnic minorities (Black, Hispanic, White), both men and women, across a broad age of distribution...
February 2014: International Journal of Epidemiology
Narissa J Nonzee, June M McKoy, Alfred W Rademaker, Peter Byer, Thanh Ha Luu, Dachao Liu, Elizabeth A Richey, Athena T Samaras, Genna Panucci, XinQi Dong, Melissa A Simon
BACKGROUND: Patient navigation programs have been launched nationwide in an attempt to reduce racial/ethnic and socio-demographic disparities in cancer care, but few have evaluated outcomes in the prostate cancer setting. The National Cancer Institute-funded Chicago Patient Navigation Research Program (C-PNRP) aims to implement and evaluate the efficacy of a patient navigation intervention for predominantly low-income minority patients with an abnormal prostate cancer screening test at a Veterans Affairs (VA) hospital in Chicago...
2012: BMC Health Services Research
Stephen K Van Den Eeden, Jun Shan, Steven J Jacobsen, David Aaronsen, Reina Haque, Virginia P Quinn, Charles P Quesenberry
PURPOSE: We examined whether there are racial/ethnic disparities in lower urinary tract symptoms in men. MATERIALS AND METHODS: Racial/ethnic disparities were examined using the American Urological Association symptom index in 2 large cohorts, including the California Men's Health Study and the Research Program in Genes, Environment and Health. Prevalence and incidence were calculated in each age and race/ethnicity strata. Multivariate analysis was done to assess the association between race/ethnicity and lower urinary tract symptoms...
January 2012: Journal of Urology
Jonathan C Routh, Melanie Pennison, Ilina Rosoklija, Sarah Dobbins, Paul J Kokorowski, Katherine C Hubert, Lin Huang, Caleb P Nelson
PURPOSE: We have previously shown that nonwhite patients with ureteropelvic junction obstruction undergo pyeloplasty at a younger age than white patients. The mechanisms behind this finding are unclear, since there is no known racial variation in the natural history of ureteropelvic junction obstruction. We used a detailed clinical database to explain this phenomenon. MATERIALS AND METHODS: We retrospectively reviewed all patients undergoing primary pyeloplasty at our institution between 1992 and 2008...
December 2011: Journal of Urology
Craig Evan Pollack, Justin E Bekelman, Andrew J Epstein, Kaijun Liao, Yu-Ning Wong, Katrina Armstrong
BACKGROUND: Patients who receive surgery from high-volume surgeons tend to have better outcomes. Black patients, however, are less likely to receive surgery from high-volume surgeons. OBJECTIVE: Among men with localized prostate cancer, we examined whether disparities in use of high-volume urologists resulted from racial differences in patients being diagnosed by high-volume urologists and/or changing to high-volume urologists for surgery. RESEARCH DESIGN: Retrospective cohort study from Surveillance, Epidemiology, and End Results-Medicare data...
November 2011: Medical Care
John B Klein, Carvell T Nguyen, Lateef Saffore, Charles Modlin, Charles S Modlin
In the United States, disparities in health care delivery and access are apparent between different racial and ethnic groups. Minorities, including African Americans, often suffer disproportionately from disease compared to Caucasians. In the urologic arena, this is apparent in urologic cancer screening, treatment choices, and survival, as well as in the arena of chronic kidney disease, transplant allocation, and transplant outcomes. Latino men also seem to be affected more often by erectile dysfunction than Caucasian counterparts...
February 2010: Journal of the National Medical Association
Anthony N Imudia, Awoniyi O Awonuga, Tarek Dbouk, Sanjeev Kumar, Marcos Cordoba, Michael P Diamond, Ray O Bahado-Singh
This study was undertaken to compare the risk factors, indications for and complications rates of cesarean hysterectomy in patient from two different ethnic backgrounds-whites and nonwhites-using patients who had cesarean hysterectomy in the Detroit Medical Center from 1991-2007. During the study period, there were 42599 cesarean deliveries, making the incidence of cesarean hysterectomy to be 3.7 per 1000 cesarean deliveries. Of the 158 cases, 8.9% were planned, while 91.1% were emergent. Among the emergent cases, nonwhites were more likely to have a higher parity (median [range], 3 [0-13] vs...
June 2009: Journal of the National Medical Association
Nitya Abraham, Fei Wan, Chantal Montagnet, Yu-Ning Wong, Katrina Armstrong
PURPOSE: We compared how men with incident prostate cancer were staged before and after the 1995 publication of National Comprehensive Cancer Network, American Urological Association and American College of Radiology staging guidelines, and determined whether there were racial differences in the staging evaluation. MATERIALS AND METHODS: We performed a retrospective cohort study of the use of bone scan and pelvic imaging (pelvic computerized tomography or magnetic resonance imaging) in 96,986 men with incident prostate cancer from 1991 to 1994 compared to 1995 to 1999 from Surveillance, Epidemiology and End Results-Medicare linked data files...
July 2007: Journal of Urology
Daniel L Howard, Bennett G Edwards, Kimberly Whitehead, M Ahinee Amamoo, Paul A Godley
CONTEXT: The reasons for African-American men to seek care for lower urinary care symptoms has not been determined due to sparse population-based data. OBJECTIVE: Our study examines the solicitation and receipt of medical care for urinary symptoms among racially oversampled elderly urban and rural cohort of African Americans and whites. DESIGN: Longitudinal analyses were conducted on five North Carolina counties through the Piedmont Health Survey of the Elderly Established Populations for the Epidemiological Study of the Elderly...
April 2007: Journal of the National Medical Association
Jennifer T Anger, Larissa V Rodríguez, Qin Wang, Er Chen, Chris L Pashos, Mark S Litwin
PURPOSE: The relationship between urinary incontinence and race/ethnicity is poorly understood. We analyzed Medicare claims data to identify racial differences in the diagnosis, treatment and outcomes of women with stress urinary incontinence. MATERIALS AND METHODS: We analyzed the 1999 to 2001 Medicare Public Use Files provided by the Centers for Medicare and Medicaid Services on a 5% national random sample of beneficiaries. Women 65 years or older with a diagnosis of stress urinary incontinence were identified on the basis of International Classification of Diseases, 9th revision codes...
May 2007: Journal of Urology
Andrea D Gurmankin, Daniel Polsky, Kevin G Volpp
Conclusions regarding racial differences in care following a newly elevated prostate-specific antigen (PSA) test at the Department of Veterans Affairs (VA) may differ depending on whether follow-up care outside the VA is considered. Consecutive Philadelphia, Pa, VA patients with newly elevated PSA tests (n = 183) were interviewed 1 year after baseline. Among exclusive VA users, Blacks had higher rates of urology referrals and prostate biopsies compared with Whites. However, these racial differences were attenuated when care obtained outside the VA also was considered...
December 2004: American Journal of Public Health
Vickie L Shavers, Martin Brown, Carrie N Klabunde, Arnold L Potosky, William Davis, Judd Moul, Angela Fahey
BACKGROUND: Previous studies have found that racial/ethnic minority patients with prostate cancer are more frequently managed with "watchful waiting." Little, however, is known about the medical care received among men managed with watchful waiting. We examine the type and intensity of medical monitoring received by African American, Hispanic, and white patients with prostate cancer managed with "watchful waiting" in fee-for-service systems. METHODS: Surveillance Epidemiology and End Results-Medicare data for men diagnosed with prostate cancer 1994-1996 were used in this study...
March 2004: Medical Care
Aruna V Sarma, John T Wei, Debra J Jacobson, Rodney L Dunn, Rosebud O Roberts, Cynthia J Girman, Michael M Lieber, Kathleen A Cooney, David Schottenfeld, James E Montie, Steven J Jacobsen
OBJECTIVES: To determine the magnitude of racial disparity in lower urinary tract symptom (LUTS) severity and bother by combining two large comparable epidemiologic studies of community-dwelling white and black men, thereby avoiding many of the referral biases present in previous studies. Prior studies evaluating racial differences in benign prostatic hyperplasia have been hampered by selection bias, because nearly all have used surgical treatment as a marker for benign prostatic hyperplasia...
June 2003: Urology
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