Race and Socioeconomic Status are Independently Associated With Benign Prostatic Hyperplasia

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Abstract
Prostate enlargement is common as men age. However, differences in the diagnosis or treatment of clinical benign prostatic hyperplasia between black and white men remain poorly understood. We investigated racial differences in and surgical intervention for benign prostatic hyperplasia in a large and predominantly low income population. Participants included 21,949 men, of whom 79.8% were black and 20.2% were white, recruited from 60 community health centers in the southeastern United States between 2002 and 2007. Benign prostatic hyperplasia, surgical intervention for benign prostatic hyperplasia, and economic and demographic indexes, eg education, household income, health insurance and marital status, were determined by an interview in person. Logistic regression was used to summarize the association between race and benign prostatic hyperplasia while controlling for health care access and socioeconomic status. Black men were approximately half as likely to report a benign prostatic hyperplasia diagnosis compared to white men (4.1% vs 9.9%, age adjusted OR 0.45, 95% CI 0.40, 0.51), a difference that persisted with only small abatement after controlling for age, income, insurance coverage, comorbidity, education and other factors (adjusted OR 0.49, 95% CI 0.43, 0.56)). Of men with benign prostatic hyperplasia surgical intervention for that condition (133 patients) was more prevalent in black vs white men (12.9% vs 9.1%, adjusted OR 1.65, 95% CI 1.10, 2.48). After controlling for economic factors associated with benign prostatic hyperplasia black men were significantly less likely to report a prior benign prostatic hyperplasia diagnosis. In contrast, surgical intervention typically reserved for severe benign prostatic hyperplasia was more common in black men. Our results suggest that race and socioeconomic status are independently associated with benign prostatic hyperplasia.

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