Factors Associated with Racial and Ethnic Disparity in Quality of Prostate Cancer Care Among Veterans and Non-Veterans
Abstract
Prostate cancer is the most common cancer among men in the United States (both Veterans and non-Veterans) and the second most common cause of cancer-related death. Racial and ethnic differences in healthcare are a major quality problem among Veterans and non-Veterans with prostate cancer. The burden of cancer in the United States will continue to grow due to aging of the population and improved survival due to better treatments. At the state level, prostate cancer patients show great variability in healthcare use, illness, and other outcomes. The quality of prostate cancer care is a construct, with several dimensions such as structure, process, and outcomes. Disparities exist in the quality of prostate cancer care across regions, hospitals, age, and racial/ethnic groups. Reasons for such variations include differences in access to care, hospital attributes, patients’ preferences, demographics, diet, genetics, geography, and insurance. Apart from private health insurance, Medicaid and Medicare are important sources of health coverage for qualified poor and for persons aged 65 or older, respectively. Dual-eligible persons are those Veterans and non-Veterans who qualify for more than one source of health coverage. Prostate cancer diagnosis brings about major changes in a patient’s life and can cause fear, anxiety, and depression. Among prostate cancer patients, depression and substance use are common comorbid conditions and can have substantial negative effects on outcomes of care. While treatments for co-occurring depression and substance use are beneficial, the uptake of these treatments remains low. Currently, we have limited knowledge about the association between health insurance status, continuity of care, and psychiatric comorbidities with racial and ethnic disparity in process of care and outcomes among prostate cancer patients. The overall objective of our study is to assess among Veterans and non-Veterans with prostate cancer, the complex interplay of predisposing factors (race and ethnicity); enabling factors (health insurance status, continuity of care); and need factors (cancer stage, depression, and substance use) and its association with disparity in care and outcomes such as complications, health service use, cost of care, and survival (overall and cancer-related) in the pre- and post-Affordable Care Act (ACA) periods. We propose a retrospective cohort control study using data from Medicaid, Medicare, states’ cancer registries, and the Veterans Information Systems and Technology Architecture (VistA) for the period between 2000 and 2017. All male Veterans and non-Veterans, aged > 40, who resided in Pennsylvania PA), New Jersey (NJ), South Carolina (SC), and North Carolina (NC) and were enrolled in Medicaid, Medicare, the Veterans’ Health Administration (VHA), or were dual-eligible over the study period and were diagnosed with prostate cancer between 2000 and 2017 will be eligible for inclusion in the study. We will select a comparison group of men without prostate cancer and of comparable age, ethnicity, and other health conditions from Medicaid, Medicare, and VistA. Data on screening, type of and time to prostate cancer treatment, use of health services, cost of care, survival and other complications will be obtained from these databases. Additionally, within our prostate cancer cohort, we will identify those with a diagnosis of depression (or substance use) and any treatments for depression (or substance use). For testing Specific Aim 1, we will assess the contribution of health insurance status (Medicaid, Medicare, and dual-eligible) to the racial/ethnic disparities in process of care and outcomes in Veterans and non-Veterans with prostate cancer. For testing Specific Aim 2, we will assess the contribution of health insurance (Medicaid, Medicare, or dual-eligible status) in the racial and ethnic disparities in process of care and outcomes in Veterans and non-Veterans with prostate cancer
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jul 16, 2019
- Source ID
- W81XWH1910461
Entities
People
- Ravishankar Jayadevappa
Organizations
- United States Army
- University of Pennsylvania