Understanding racial disparities in survival among U.S. veterans with localized high-risk prostate cancer, 2004-2019.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 202-202
Author(s):  
Ravi Bharat Parikh ◽  
Sumedha Chhatre ◽  
Ruchika Talwar ◽  
Elina Medvedeva ◽  
John Cashy ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Racial Disparities ◽  
Veterans Health Administration ◽  
Equal Access ◽  
Localized Prostate Cancer ◽  
Veterans Health ◽  
Health Administration ◽  
Electronic Health Record Data ◽  
Term Survival

202 Background: Known racial disparities in prostate cancer outcomes between African-American (AA) and non-Hispanic White (W) men may be ameliorated in the Veterans Health Administration (VA), a large national equal-access health system. We examined factors contributing to racial disparities in mortality among men with high-risk localized prostate cancer diagnosed in the VA. Methods: In this retrospective cohort study, we used linked administrative, survey, and electronic health record data from the Veterans Health Administration (VA) Corporate Data Warehouse to identify AA and W Veterans who were diagnosed with high-risk localized PC, as defined by D’Amico criteria, between January 1, 2004 and December 31, 2013. Patients were followed through December 31, 2019. The primary outcome was all-cause mortality. We used hierarchical Cox regression models, sequentially adjusting for covariates related to social determinants of health (e.g. travel time, marital status), clinical factors at diagnosis (e.g. PSA, Gleason, comorbidity), diagnosing facility, and prostate cancer treatment and adherence to American Cancer Society survivorship care guidelines. Results: Among 21,338 Veterans receiving continuous VA-based care (median age at diagnosis 66 years [interquartile range [IQR] 61-74]), 7,472 (28.7%) were AA, 9,404 (44.1%) died, and median follow-up was 8.4 years (IQR 6.1-11.1). After adjusting for all covariates, AA Veterans (adjusted hazard ratio [aHR] 0.84, 95% confidence interval [CI] 0.83-0.91) had improved overall survival compared to W Veterans. This association persisted in all hierarchical regressions (see Table), was present in all pre-specified subgroups, and was strongest among Veterans living in rural domiciles (aHR 0.70, 95% CI 0.64-0.77). Conclusions: AA Veterans with high-risk localized prostate cancer had improved long-term survival compared to W Veterans, which stands in contrast to prior studies among non-Veterans. Equal access to care may improve racial disparities in prostate cancer, although future studies should clarify mechanisms of improved survival for AA Veterans with prostate cancer in order to provide insights for ameliorating outcome disparities in non-Veterans with prostate cancer. [Table: see text]

scholarly journals Overall Survival in Patients with Localized Prostate Cancer in the US Veterans Health Administration: Is PIVOT Generalizable?

2016 ◽  
Vol 70 (2) ◽  
pp. 227-230 ◽  
Author(s):  
Philip V. Barbosa ◽  
I-Chun Thomas ◽  
Sandy Srinivas ◽  
Mark K. Buyyounouski ◽  
Benjamin I. Chung ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Veterans Health Administration ◽  
Localized Prostate Cancer ◽  
Veterans Health ◽  
Health Administration ◽  
The Us ◽  
Us Veterans

Racial disparities in definitive treatment and long-term mortality among US veterans with high-risk localized prostate cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19037-e19037
Author(s):  
Ravi Bharat Parikh ◽  
Kyle William Robinson ◽  
Sumedha Chhatre ◽  
Elina Medvedeva ◽  
S. Bruce Malkowicz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
High Risk ◽  
Racial Disparities ◽  
Equal Access ◽  
Localized Prostate Cancer ◽  
High Risk Prostate Cancer ◽  
All Cause Mortality ◽  
Risk Prostate Cancer ◽  
Long Term Mortality

e19037 Background: Equal access to care may mediate racial disparities among men with localized prostate cancer. We examined the association between African-American race and long-term mortality among men with high-risk prostate cancer in a large equal-access health system. Methods: In this retrospective cohort study, we used the VA Corporate Data Warehouse to identify African-American (AA) and non-Hispanic White Veterans diagnosed with high-risk (prostate-specific antigen [PSA] ≥ 20 ng/mL, Gleason 8-10, or stage ≥ cT2c) localized prostate cancer between January 1st, 2001 and December 31st, 2011 and followed through January 1st, 2019. Veterans who did not receive continuous VA care were excluded. We used descriptive statistics to compare type of therapy received and multivariable Cox proportional hazards regressions to estimate the association between mortality and race. Cox models were adjusted for age, pre-treatment PSA, year of diagnosis, enrollment priority (an individual-level proxy for income and disability need), marital status, Elixhauser comorbidity index, and primary treatment. Results: Among 14,877 Veterans (median age 67 years [interquartile range [IQR] 62-75]), 4,160 (28.0%) were AA. Median followup was 9.0 years (IQR 6.1-11.4). Compared to White men, AA men were more likely to have PSA ≥ 20 (49.9% vs. 40.9%), be unmarried (59.3% vs. 43.3%), have ≥3 comorbidities (46.4% vs. 41.0%), and have high disability and income need (22.0% vs. 18.6%) (all p < 0.001). Over time, AA Veterans were consistently less likely to receive prostatectomy (18.9% vs. 24.9%). Crude mortality rates were 50.6 and 61.6 deaths per 1000 patient-years for AA and White Veterans, respectively. After adjusting for all covariates, AA Veterans had lower all-cause mortality (adjusted hazard ratio [aHR] 0.83, 95% CI 0.79-0.88, p < 0.001) compared to White Veterans. This association was consistent across pre-specified subgroups (Table). Conclusions: Among men with high-risk prostate cancer who received continuous care within a large equal-access health system, African-Americans had lower all-cause mortality compared to Whites. Equal access to care may mitigate or reverse traditional racial disparities in mortality among men with prostate cancer. [Table: see text]

Racial disparities in depression incidence, management, and mortality after prostate cancer diagnosis.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 201-201
Author(s):  
Ravi Bharat Parikh ◽  
Joseph J. Gallo ◽  
John Cashy ◽  
Kyle William Robinson ◽  
Vivek Narayan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
African American ◽  
Depressive Disorder ◽  
Racial Disparities ◽  
Cox Regression ◽  
African American Men ◽  
Veterans Health ◽  
Health Administration ◽  
Electronic Health Record Data ◽  
All Cause Mortality

201 Background: Depressive disorder is a common cause of morbidity among men with prostate cancer (PC) and may contribute to known racial disparities in PC outcomes. We estimated the incidence, management, and impact of depressive disorder (depression) on overall mortality among African American (AA) and non-Hispanic White (W) Veterans with localized PC. Methods: In this retrospective cohort study, we used linked administrative, survey, and electronic health record data from the Veterans Health Administration (VA) Corporate Data Warehouse to identify AA and W Veterans with no preexisting depression who were diagnosed with localized PC between January 1, 2004 and December 31, 2013. Patients were followed through December 31, 2019. The primary outcomes were incident depression (defined from diagnosis codes and PHQ-2 and -9 screenings between six months to five years after PC diagnosis), receipt of anti-depressant therapy, and all-cause mortality. We used logistic and Cox regression models, adjusted for sociodemographic factors, PSA, Gleason score, and prostate cancer treatment, to estimate associations with all outcomes, using race-by-depression and race-by-treatment interaction terms to investigate racial disparities. Results: Among 32,194 Veterans diagnosed with localized prostate cancer (median age 67 years [interquartile range [IQR] 62 to 73 years], median follow-up 9.9 years [IQR 8.0 to 12.1 years]), 8,177 (25.4%) were AA. Overall, 8,285 (25.7%) Veterans were diagnosed with depression after PC diagnosis, and 2,525 (30.5%) of depressed Veterans received an antidepressant. Compared to Veterans without depression, Veterans with incident depression had higher all-cause mortality (adjusted hazard ratio [aHR] 1.30 [95% CI 1.25-1.35]). Race moderated all outcomes: AAs were more likely than Ws to be diagnosed with depression. However, among those with depression, AAs were less likely than Ws to receive an antidepressant. Interaction analyses showed that the HR of all-cause mortality associated with depression among AAs was significantly greater than that of Ws. Antidepressant receipt was not associated with improved mortality (aHR 1.05 [95% CI 0.97-1.13]); this finding was not moderated by race. Conclusions: Depression was common among men with prostate cancer within a large equal-access health care system, and African American men had more adverse depression-related outcomes than White men. Identifying and managing incident depression should be a key target of efforts to improve prostate cancer outcomes and disparities. [Table: see text]

An Intervention With Meaning

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 376-383 ◽  
Author(s):  
Brooke A. Levandowski ◽  
Constance M. Cass ◽  
Stephanie N. Miller ◽  
Janet E. Kemp ◽  
Kenneth R. Conner
Keyword(s):  
High Risk ◽  
Qualitative Methodology ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Safety Planning ◽  
Health Administration ◽  
Suicide Method ◽  
Treatment Providers ◽  
Interactive Nature ◽  
Behavioral Health Treatment

Abstract. Background: The Veterans Health Administration (VHA) health-care system utilizes a multilevel suicide prevention intervention that features the use of standardized safety plans with veterans considered to be at high risk for suicide. Aims: Little is known about clinician perceptions on the value of safety planning with veterans at high risk for suicide. Method: Audio-recorded interviews with 29 VHA behavioral health treatment providers in a southeastern city were transcribed and analyzed using qualitative methodology. Results: Clinical providers consider safety planning feasible, acceptable, and valuable to veterans at high risk for suicide owing to the collaborative and interactive nature of the intervention. Providers identified the types of veterans who easily engaged in safety planning and those who may experience more difficulty with the process. Conclusion: Additional research with VHA providers in other locations and with veteran consumers is needed.

scholarly journals Determinants of quality prostate cancer survivorship care across the primary and specialty care interface: Lessons from the Veterans Health Administration

2019 ◽  
Vol 8 (5) ◽  
pp. 2686-2702 ◽  
Author(s):  
Archana Radhakrishnan ◽  
Jennifer Henry ◽  
Kevin Zhu ◽  
Sarah T. Hawley ◽  
Brent K. Hollenbeck ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Survivorship ◽  
Veterans Health Administration ◽  
Specialty Care ◽  
Veterans Health ◽  
Survivorship Care ◽  
Health Administration

The Management of Newly-Diagnosed Non-muscle Invasive Bladder Cancer in Veterans Integrated Services Network 02 of the Veterans Health Administration

2019 ◽  
Author(s):  
Joseph M Caputo ◽  
George Moran ◽  
Benjamin Muller ◽  
Alison T Keller ◽  
Gen Li ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Newly Diagnosed ◽  
Health Administration ◽  
Muscle Invasive Bladder Cancer ◽  
High Risk Patients ◽  
Risk Patients ◽  
Muscle Invasive

Abstract Introduction Over 1,500 bladder cancers were diagnosed among US Veterans in 2010, the majority of which were non-muscle invasive bladder cancer (NMIBC). Little is known about NMIBC treatment within the Veterans Health Administration. The objective of the study was to assess the quality of care for Veterans with newly-diagnosed NMIBC within Veterans Integrated Service Network (VISN) 02. Materials and Methods We used ICD-9 and ICD-10 codes to identify patients with newly-diagnosed bladder cancer from 1/2016–8/2017. We risk-stratified the patients into low, intermediate, and high-risk based on the 2016 American Urological Association Guidelines on NMIBC. Our primary objectives were percentages of transurethral resection of bladder tumors (TURBTs) with detrusor, repeat TURBT in high-risk and T1 disease, high-risk NMIBC treated with induction intravesical therapy (IVT), and responders treated with maintenance IVT. We performed logistic regression for association between distance to diagnosing hospital and receipt of induction IVT in high-risk patients. Results There were 121 newly-diagnosed NMIBC patients; 16% low-risk, 28% intermediate-risk, and 56% high-risk. Detrusor was present in 80% of all initial TURBTs and 84% of high-risk patients. Repeat TURBT was performed in 56% of high-risk NMIBC and 60% of T1. Induction IVT was given to 66% of high-risk patients and maintenance IVT was given to 59% of responders. On multivariate logistic regression, distance to medical center was not associated with receipt of induction IVT (OR = 0.99, 95% CI [0.97,1.01], p = 0.52). Conclusions We observed high rates of sampling of detrusor in the first TURBT specimen, utilization of repeat TURBT, and administration of induction and maintenance intravesical BCG for high-risk patients among a regional cohort of US Veterans with NMIBC. While not a comparative study, our findings suggest high quality NMIBC care in VA VISN 02.

scholarly journals Survival and Causes of Death Among Veterans With Lower Extremity Revascularization With Paclitaxel‐Coated Devices: Insights From the Veterans Health Administration

2021 ◽  
Vol 10 (4) ◽  
Author(s):  
Jorge Antonio Gutierrez ◽  
Sunil V. Rao ◽  
William Schuyler Jones ◽  
Eric A. Secemsky ◽  
Aaron W. Aday ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Veterans Health Administration ◽  
Endovascular Intervention ◽  
Veterans Administration ◽  
Veterans Health ◽  
Coding System ◽  
Health Administration ◽  
Term Survival ◽  
All Cause Mortality

BACKGROUND The long‐term safety of paclitaxel‐coated devices (PCDs; drug‐coated balloon or drug‐eluting stent) for peripheral endovascular intervention is uncertain. We used data from the Veterans Health Administration to evaluate the association between PCDs, long‐term mortality, and cause of death. METHODS AND RESULTS Using the Veterans Administration Corporate Data Warehouse in conjunction with International Classification of Diseases, Tenth Revision ( ICD‐10 ) Procedure Coding System, Current Procedural Terminology, and Healthcare Common Procedure Coding System codes, we identified patients with peripheral artery disease treated within the Veterans Administration for femoropopliteal artery revascularization between October 1, 2015, and June 30, 2019. An adjusted Cox regression, using stabilized inverse probability–weighted estimates, was used to evaluate the association between PCDs and long‐term survival. Cause of death data were obtained using the National Death Index. In total, 10 505 patients underwent femoropopliteal peripheral endovascular intervention; 2265 (21.6%) with a PCD and 8240 (78.4%) with a non‐PCD (percutaneous angioplasty balloon and/or bare metal stent). Survival rates at 2 years (77.4% versus 79.7%) and 3 years (70.7% versus 71.8%) were similar between PCD and non‐PCD groups, respectively. The adjusted hazard for all‐cause mortality for patients treated with a PCD versus non‐PCD was 1.06 (95% CI, 0.95–1.18, P =0.3013). Among patients who died between October 1, 2015, and December 31, 2017, the cause of death according to treatment group, PCD versus non‐PCD, was similar. CONCLUSIONS Among patients undergoing femoropopliteal peripheral endovascular intervention within the Veterans Administration Health Administration, there was no increased risk of long‐term, all‐cause mortality associated with PCD use. Cause‐specific mortality rates were similar between treatment groups.

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