Disparities in Prostate Cancer Diagnosis, Treatment, and Survival Among Men with Disabilities

Background: Disparities in the diagnosis, treatment, and survival of prostate cancer (PC) patients according to disability status have not been widely investigated. Methods: A retrospective cohort study using disability registration data linked to Korean National Health Insurance and national cancer registry data. 7,924 PC patients with disabilities and 34,188 age-matched PC patients without disability were included. Results: While stage distribution at diagnosis was similar, unknown stage was more common in patients with severe disabilities compared to those without disabilities (18·1% vs. 16·2%, respectively). People with disabilities were less likely to undergo surgery (33·1% vs. 38·6%, respectively; adjusted odds ratio [aOR] 0.79, 95% confidence interval [CI] 0.74-0.84), and more likely to receive androgen deprivation therapy (ADT) (57·9% vs. 55.0%, respectively; aOR 1·10, 95% CI 1·04-1·16) compared to those without disabilities. This was more evident for people with severe brain/mental impairment (aORs 0·29 for surgery; 1·52 for ADT). Patients with disabilities had higher overall mortality (adjusted hazard ratio [aHR] 1·20; 95% CI, 1·15-1·25), but only slightly higher PC-specific mortality after adjustment for patient factors and treatment (aHR 1·11, 95% CI 1·04-1·18) than people without disability. Interpretation: PC patients with disabilities underwent less staging work-up and were more likely to receive ADT than surgical treatment. Overall mortality of PC patients with disabilities was greater than those of PC patients without disability, but PC-specific mortality was only slightly worse. Unequal clinical care in this vulnerable population suggests the presence of disability-related barriers that need to be addressed. Funding Statement: This work was supported by an R&D grant (No. 2016007) from the Korea National Rehabilitation Center Research Institute, Ministry of Health & Welfare, and the National Research Foundation of Korea(NRF) grant funded by the Ministry of Education (No.2016R1D1A3B03931142) and by the Korea government(MSIT) (No. 2019R1H1A2080180, 2019R1A2C1087507). Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: Institutional Review Board approval was obtained from Chungbuk National University (IRB No. CBNU-201708-BM-501-01).