Differences in healthcare expenditures and utilization by race for common benign urologic conditions
Michael Rezaee, MD, MPH1, Charlotte Ward, PhD2, Martin Gross, MD1.
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 2Dartmouth College, Lebanon, NH, USA.
BACKGROUND: Little is known about racial disparities in the care of urology patients. We sought to identify differences in healthcare expenditures and utilization by race in patients treated for common benign urologic conditions.
METHODS: A retrospective secondary data analysis was conducted of patients with common benign urologic conditions using 2016-2018 Medical Expenditure Panel Survey data. Benign conditions included urolithiasis, cystitis, erectile dysfunction (ED), pelvic organ prolapse (POP), urinary incontinence (UI), and benign prostatic hyperplasia (BPH). Generalized linear models were used to evaluate the relationship between total healthcare expenditures and utilization and race for each condition. Adjusted analyses accounted for age, sex, number of chronic conditions, poverty category, self-reported health status, marital status, highest degree of educational attainment, insurance status, and survey year.
RESULTS: The weighted analysis sample consisted of 27,110,416 patients, of whom 80.9% were Non-Hispanic white, 6.9% Non-Hispanic black, and 12.2% other minority races. After adjustment, total healthcare expenditures were significantly lower for Non-Hispanic blacks (Incidence Rate Ratio [IRR] = 0.19, 95% CI: 0.06 - 0.61) and other minority races (IRR = 0.30, 95% CI: 0.10 - 0.88) treated for ED compared to Non-Hispanic whites (Figure 1). Similarly, compared to Non-Hispanic whites, healthcare expenditures were significantly lower for Non-Hispanic blacks treated for UI (IRR = 0.56, 95% CI: 0.35 - 0.90). After adjustment, Non-Hispanic blacks (IRR = 0.71, 95% CI: 0.53 - 0.94) and other minority races (IRR = 0.83, 95% CI: 0.69 - 0.99) had significantly lower total healthcare utilization for cystitis and BPH respectively.
CONCLUSIONS: Healthcare expenditures are significantly lower for Non-Hispanic blacks treated for ED and UI in the U.S. Utilization is also significantly lower for Non-Hispanic blacks and other minority races treated for cystitis and BPH respectively. Future research is needed to determine if these differences represent an inequality in the delivery of urologic care for patients with these conditions.
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