Healthcare System Drivers of Prostate Cancer Disparities: Real-World Evidence, Informatics Pathways, and Policy Translation.

Background

Racial and socioeconomic differences in prostate cancer outcomes are often described as survival disparities, but observed differences may also reflect healthcare access, treatment delivery, and resource allocation.

Methods

NCDB and SEER-Medicare were treated as independent, complementary retrospective data sources without individual-level linkage. The analytic material comprised 111,396 database records from 2010 to 2020 across two independent source files; this is a cross-source record count, not a deduplicated count of unique persons. Harmonized descriptive analyses characterized stage, treatment, and treatment timing, while multivariable Cox proportional hazards modeling evaluated prostate cancer-specific survival (CSS) in outcome-eligible SEER-Medicare records. The CSS model denominator is therefore substantially smaller than the total record count, and the two should not be confused.

Results

Records for non-Hispanic Black (NHB) men more often showed stage III-IV disease than records for non-Hispanic White (NHW) men (26.9% vs. 18.7%) and lower receipt of guideline-concordant first-course management initiated within 90 days, particularly in the low-SES subgroup (51.4% vs. 84.3% among high-SES NHW men). In the adjusted CSS model, NHB race was associated with higher mortality (HR = 1.32; 95% CI: 1.24-1.41). Uninsured status (HR = 1.47; 95% CI: 1.33-1.62), low income (HR = 1.28; 95% CI: 1.19-1.37), and rural residence (HR = 1.14; 95% CI: 1.06-1.22) were also associated with higher mortality.

Conclusions

The findings support a healthcare-system interpretation of prostate cancer disparities and identify measurable targets for prospective evaluation, including EHR-enabled monitoring, nurse navigation, telehealth-supported follow-up, and facility-level treatment-concordance review.