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Prostate Cancer: Localized: Surgical Therapy II (PD19): Podium 19: Saturday, September 11, 2021


Jayadevappa, Ravishankar; Chhatre, Sumedha; Parikh, Ravi B; Malkowicz, S Bruce

doi: 10.1097/JU.0000000000002008.06
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African American men are less likely to receive surgery and but exhibit impaired outcomes, compared to white. Access to care has been associated with racial disparity in treatment and outcomes. A goal of Medicaid expansion is to enhance access to care, therefore, we examined if Medicaid expansion was associated with reduced racial disparity in surgery treatment and quality of care (30 day mortality, 90 day mortality and 30-day readmission) among surgical patients with localized prostate cancer.


This was a retrospective study using the National Cancer Database. Eligible prostate cancer patients were aged ≥ 18 and younger than 65, African American or white race, diagnosed between 2010 and 2015, localized disease stage and receiving surgery treatment. A patient’s state was dichotomized as Medicaid expansion vs. non-expansion. Outcomes were 30 day and 90 day post-surgical mortality, and readmission within 30 days of surgical discharge. Logistic regression model was used to study the association between 30 day mortality and race, and Medicaid expansion status. The models adjusted for age, facility type, insurance status, rural/urban status, stage, and comorbidity. We also studied the interaction of race and Medicaid expansion. Similar models were used for outcomes of 90 day mortality and 30 day readmission.


We identified 620,420 men with prostate cancer who met our criteria. In the non-expansion group, 58% of African Americans has surgery and 74% of white had surgery (p <.0001). In the Medicaid expansion group, this proportion was 57% vs 70%, respectively (p <.0001). Among the 152,532 surgical patients in our cohort, odds of 30 day mortality, 90 day mortality and 30 day readmission were comparable between Medicaid expansion and non-expansion groups. Compared to whites, African Americans had higher odds of 30 day mortality, 90 day mortality and 30 day readmission. The interaction term showed that African Americans continued to have impaired outcomes, irrespective of Medicaid expansion (Table 1).


Racial disparity in surgery uptake as well as quality of care measures persisted, and did not differ by Medicaid expansion status. Research is needed to identify other patient and provider level factors that may affect the observed racial disparity in prostate cancer care and outcomes.

Source of Funding:

Department of Defense Health Disparity Scholar Award (W81XWH1910461)

© 2021 by American Urological Association Education and Research, Inc.