Abstract B100: The role of place in racial disparities in prostate cancer treatment

Abstract In this analysis, we investigate the role of place—where patients live and seek care— in treatment disparities between Black and White men with localized prostate cancer to better understand why these disparities exist. Research has shown that Black men are less likely to undergo treatment for localized prostate cancer, a disease in which Black men are twice as likely to die, independent of their health. Our study examines place as a potential contributor to this disparity. Our analysis uses fixed effects, a statistical approach that investigates characteristics that are constant within a given level of place, within a multivariate regression framework to assess the role of place as a potential driver of the treatment disparity. Our data sample consists of men in the SEER-Medicare (2005-2016) claims data with clinically significant, non-metastatic prostate cancer who identified as either Black or White. Our analysis also includes comorbidities and cancer characteristics to capture patient health. We assess physician, hospital, and SEER-region fixed effects to investigate the role of selection on treatment disparities[YN1] . Physician fixed effects compare how each physician differentially treats Black and White patients relative to that physician’s average treatment rate to adjust for the role of physician selection. ZIP code fixed effects adjust for all time-invariant factors that occur at that geographic level to investigate the role of where patients live on the treatment disparity. Our results indicate that place, as individual or aggregated levels of fixed effects, plays a minimal role in the prostate cancer treatment disparity. This finding points toward the inadequacy of the explanation that it is where patients live or seek care that drives the observed differences in treatment. Instead of health or place, it is the race of the patient that drives the treatment inequity. The finding is consistent with understanding race as a social construct with racism as an individual, system, and structural phenomenon. These findings provide an important beginning towards understanding why current practices are inequitable, a necessary intermediate step toward understanding equitable care and the ultimate goal of designing interventions to solve this inequity. Citation Format: Noah Hammarlund, Jenney Lee, Erika Wolff, Sarah Holt, Ruth Etzioni, John Gore, Yaw A. Nyame. The role of place in racial disparities in prostate cancer treatment [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B100.