The Influence of Patient Race and Social Vulnerability on Urologist Treatment Recommendations in Localized Prostate Carcinoma

Abstract

Background In localized prostate carcinoma (PCa), many studies have found that black subjects receive radical prostatectomy (RP) less often than white subjects. Such disparities involve barriers to health care, comorbid illnesses, tumor characteristics, and patient preferences. It is unclear whether differences in urologist treatment recommendations also might play a role. Methods Using a randomized, 2 x 2 factorial design, we presented 2000 urologists with a clinical vignette and asked them to recommend treatment of a healthy 70-year-old patient with low-risk, clinically localized PCa. Options included either RP, external beam radiotherapy, brachytherapy, cryotherapy, observation, or hormonal therapy. There were 2 variables within 4 otherwise-identical versions of the vignette: 1) patient race (black vs. white) and 2) social vulnerability (middle-income and married vs. low-income and widowed). We used multivariable logistic regression to model the effects of patient race, social vulnerability, and their interaction on recommendations for RP versus radiotherapy. Results The response rate was 66.1% (n = 1313). Race and social vulnerability interacted (P = 0.05) such that the highly vulnerable black patient received an RP recommendation 14.4% less often than his less vulnerable counterpart; the difference between the 2 white patients was 4.2%. Discussion Race interacts with social vulnerability to influence urologist recommendations for RP. Because PCa tends to be more lethal i…