REMOVAL OF THE FINANCIAL BARRIER TO HEALTH-CARE - DOES IT IMPACT ON PROSTATE-CANCER AT PRESENTATION AND SURVIVAL - A COMPARATIVE-STUDY BETWEEN BLACK-AND-WHITE MEN IN A VETERANS AFFAIRS SYSTEM

Objectives African-American men are known to have a higher incidence a nd mortality rate from prostate cancer than American-Caucasian men. It is also known that African Americans have a higher incidence of advan ced stage disease at diagnosis. One hypothesis for the latter is a del ay in diagnosis due to lack of financial access to health care. Becaus e eligibility for medical care in Veterans Affairs Medical Centers (VA MCs) is similar for both black and white patients, less disparity of s tage at diagnosis, and therefore survival between blacks and whites, w ould be expected. Methods. Cases for this study included only those hi stologically confirmed, newly diagnosed prostate cancers at the Alien Park VAMC in Wayne County, Michigan, between 1973 and 1992. Trained Su rveillance, Epidemiology, and End Result (SEER) abstractors determined the stage at diagnosis, according to SEER criteria. Data analyses inc lude descriptive statistics and survival analysis. Results. The distri bution of race and annual income of all male patients seen at the VAMC in Alien Park is similar. Over the entire 20-year period (1973 to 199 2), there were a total of 358 prostate cancers in white patients and 3 83 in black patients. The ages of black and white patients were compar able. The proportion of white and black men presenting with localized disease is similar (57% and 54%, respectively). A significantly greate r proportion of black patients with prostate cancer were classified as having distant disease compared with white patients (25% versus 19%; P = 0.045). A racial ''crossover'' effect in survival occurred around age 70 years, with white men demonstrating improved survival under 70 years of age, and black men 70 years and older tending to have better survival. Conclusions. These data suggest that financial access to car e has no apparent influence on the higher proportion of distant diseas e and poorer survival of African-American patients with prostate cance r compared with American-Caucasian men.