BACKGROUND The gap in prostate cancer (PCa) survival between Blacks and Whites has widened over the past decade. Investigators hypothesize that this disparity may be partially attributable to differences in rates of definitive therapy between races. OBJECTIVE To examine facility level variation in the use of definitive therapy among Black and White men for localized PCa. DESIGN, SETTING, AND PARTICIPANTS Using data from the National Cancer Data Base, we identified 223 873 White and 59 262 Black men ≥40 yr of age receiving care within the USA with biopsy confirmed localized intermediate/high-risk PCa diagnosed between January 2004 and December 2013. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multilevel logistic regression was fitted to predict the odds of receiving definitive therapy for PCa. Sensitivity and subgroup analyses were performed to adjust for inherent patient and facility-level differences when appropriate. RESULTS AND LIMITATIONS Eighty-three percent (n=185 647) of White men received definitive therapy compared with 74% (n=43 662) of Black men between 2004 and 2013. Overall rates of definitive therapy during that time increased for both White (81% vs 83%, p<0.001) and Black (73% vs 75%, p=0.001) men. However, 39% of treating facilities demonstrated significantly higher rates of definitive therapy in White men, compared with just 1% favoring Black men. Our study is limited by potential selection bias and effect modification. CONCLUSIONS After adjusting for sociodemographic and clinical factors, we found that most facilities favored definitive therapy in Whites. Health care providers should be aware of these inherit biases when counseling patients on treatment options for localized PCa. Our study is limited by the retrospective nature of the cohort. PATIENT SUMMARY We found significant differences in rates of radiation and surgical treatment for prostate cancer among White and Black men, with most facilities favoring Whites. Nonclinical factors such as treatment facility type and location influenced rates of therapy.

中文翻译：

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为中度/高风险局部前列腺癌提供确定性治疗的种族差异：设施特征和社会经济特征的影响。

背景在过去十年中，黑人和白人之间的前列腺癌 (PCa) 存活率差距已经扩大。研究人员推测，这种差异可能部分归因于种族之间确定性治疗率的差异。目的 调查黑人和白人男性在局部 PCa 中使用确定性治疗的设施水平差异。设计、设置和参与者使用来自国家癌症数据库的数据，我们确定了 223 873 名 40 岁以上的白人男性和 59 262 名黑人男性，他们在 2004 年 1 月至 2004 年 1 月至2013 年 12 月。结果测量和统计分析 拟合多级逻辑回归来预测接受 PCa 确定性治疗的几率。进行敏感性和亚组分析，以在适当时调整固有的患者和设施水平差异。结果和局限性 在 2004 年至 2013 年期间，83% (n=185 647) 的白人男性接受了明确治疗，而黑人男性接受了明确治疗的比例为 74% (n=43 662)。在此期间，两种白人 ( 81% 对 83%，p<0.001）和黑人（73% 对 75%，p=0.001）男性。然而，39% 的治疗机构在白人男性中表现出显着更高的明确治疗率，而黑人男性中只有 1% 的人支持这一比例。我们的研究受到潜在的选择偏差和效果修正的限制。结论 在调整社会人口学和临床因素后，我们发现大多数机构倾向于对白人进行明确的治疗。在就局部 PCa 的治疗方案向患者提供咨询时，医疗保健提供者应该意识到这些遗传偏见。我们的研究受限于队列的回顾性。患者总结 我们发现白人和黑人男性前列腺癌的放射和手术治疗率存在显着差异，大多数设施偏爱白人。治疗设施类型和位置等非临床因素影响治疗率。