Disparities in disease profile among afro-brazilians and public healthcare patients with prostate cancer

Keywords

prostate cancer - equity - public policies

Introduction: Prostate cancer (PC) is a neoplasm on the rise among the Brazilian population. North American studies indicate that black men are disproportionately affected by PC, with an earlier presentation, aggressive genotype and higher mortality.

Objectives: To identify disease profile and treatment disparities among patients treated with PC.

Methods: Retrospective and prospective data, covering the period from 2017 to 2024, were used. The study evaluated patients over 18 years old diagnosed with PC, with information collected through the analysis of clinical, epidemiological, and pathological variables in their respective medical records. Parameterized data were anonymized and extracted by the hospital's Big Data/Analytics system, while non-parameterized data were obtained through manual and individual extraction of each medical record.

Results: The descriptive analysis of 2,387 patients treated at Private and Public Hospitals revealed that more than half were up to 75 years old. Regarding race, 58% of patients reported their ethnicity: 75.41% were white, 13.84% mixed-race, 7.35% black, 3.32% yellow, and 0.07% indigenous. Approximately 61.48% lived more than 10 km from their respective treatment center. SUS patients had a 2.5 times higher risk of metastasis at diagnosis (p<0.01) when compared to private service patients, and longer hospital stays (p<0.01). Regarding race, blacks (OR 2.27) and mixed-race (OR 1.89) had a higher risk of metastasis at diagnosis than whites. Furthermore, Black (OR 0.04), mixedrace (OR 0.26), yellow (OR 0.14) patients, and those >75 years old (OR 0.42) had a lower chance of undergoing robotic surgery. A distance >10 km from the treatment center reduced the chance of robotic surgery by 95% (OR 0.05, p<0.01). Patients older than 75 years old has statistically worse outcomes (p<0.01).

Conclusions: The results of this study highlight significant disparities in PC patients. Black and mixed-race patients, as well as those from the public healthcare system, faced a higher risk of metastasis at diagnosis and lower chances of accessing advanced technologies, such as robotic surgery. Additionally, advanced age and the presence of metastasis were associated with reduced overall survival and longer hospitalization. These findings underscore the need for targeted interventions to reduce treatment access inequalities and improve clinical outcomes, particularly in vulnerable populations.

Corresponding author: Ana Luiza Spina Nagy (e-mail: [e-mail]).