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Medical Care Research and Review
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*Prostate Cancer
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What's this?

Racial Differences in the Impact of Comorbidities on Survival Among Elderly Men With Prostate Cancer

Mary Putt

Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia

Judith A. Long

School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Philadelphia VA Center for Health Equity Research and Promotion, Pennsylvania

Chantal Montagnet

School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia

Jeffrey H. Silber

School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Wharton School of Business, University of Pennsylvania, Philadelphia, Center for Outcomes Research, Children's Hospital of Philadelphia, Pennsylvania

Virginia W. Chang

School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Philadelphia VA Center for Health Equity Research and Promotion, Pennsylvania

Kaijun Liao

School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia

J. Sanford Schwartz

School of Medicine, Leonard Davis Institute of Health Economics, and Wharton School of Business, University of Pennsylvania, Philadelphia

Craig Evan Pollack

School of Medicine, University of Pennsylvania, Philadelphia, Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, Philadelphia VA Center for Health Equity Research and Promotion, Pennsylvania

Yu-Ning Wong

Leonard Davis Institute of Health Economics, University of Pennsylvania and Divisions of Population Science and Medical Science, Fox Chase Cancer Center, Philadelphia, Pennsylvania

Katrina Armstrong

School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania and Abramson Cancer Center, University of Pennsylvania School of Medicine, Philadelphia, karmstro{at}mail.med.upenn.edu

This study investigates differences in the effects of comorbidities on survival in Medicare beneficiaries with prostate cancer. Medicare data were used to assemble a cohort of 65- to 76-year-old Black (n = 6,402) and White (n = 47,458) men with incident localized prostate cancer in 1999 who survived ≥1 year postdiagnosis. Comorbidities were more prevalent among Blacks than among Whites. For both races, greater comorbidity was associated with decreasing survival rates; however, the effect among Blacks was smaller than in Whites. After adjusting for age, socioeconomic status, and community characteristics, the association between increasing comorbidities and survival remained weaker for Blacks than for Whites, and racial disparity in survival decreased with increasing number of comorbidities. Differential effects of comorbidities on survival were also evident when examining different classes of comorbid conditions. Adjusting for treatment had little impact on these results, despite variation in the racial difference in receipt of prostatectomy with differing comorbidity levels.

Key Words: administrative data • comorbidity • disparities • Medicare • prostate cancer • social epidemiology • survival analysis

This version was published on August 1, 2009

Medical Care Research and Review, Vol. 66, No. 4, 409-435 (2009)
DOI: 10.1177/1077558709333996
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