Journal of Community Health

, 33:318

Racial Disparities in Access to Care for Men in a Public Assistance Program for Prostate Cancer

  • David C. Miller
  • Lillian Gelberg
  • Lorna Kwan
  • Sevan Stepanian
  • Arlene Fink
  • Ronald M. Andersen
  • Mark S. Litwin
Original Paper


California’s IMPACT program provides all its enrollees with health insurance and social service resources. We hypothesized that racial/ethnic disparities in access to care might be attenuated among men served by this program. Our objective was to evaluate racial/ethnic differences in health services utilization and patient-reported health care outcomes among disadvantaged men in a prostate cancer public-assistance program, and to identify modifiable factors that might explain persistent disparities in this health care setting. We performed a retrospective cohort study of 357 low-income men enrolled in IMPACT from 2001 through 2005. We evaluated realized access to care with two health services utilization measures: (1) use of emergency department care without hospitalization and, (2) frequency of prostate-specific antigen testing. We also measured two patient-experience outcomes: (1) satisfaction with care received from IMPACT, and (2) confidence in IMPACT care providers. We observed significant bivariate associations between race/ethnicity and patient-experience outcomes (< 0.05), but not utilization measures. In multivariable models, Hispanic men were more likely than white men to report complete satisfaction with health care received in IMPACT (adjusted OR = 5.15, 95% CI 1.17–22.6); however, the association between race/ethnicity and satisfaction was not statistically significant (P = 0.11). Language preference and self-efficacy in patient-physician interactions are potentially-modifiable predictors of patient-experience outcomes. We observed no racial/ethnic disparities in health services utilization among disadvantaged men served by a disease-specific public assistance program. The greater satisfaction and confidence among Hispanic men are explained by modifiable variables that suggest avenues for improvement.


Prostate cancer Low-income Uninsured Race/ethnicity Disparities Public assistance Self-efficacy 


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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • David C. Miller
    • 1
  • Lillian Gelberg
    • 2
  • Lorna Kwan
    • 3
  • Sevan Stepanian
    • 1
  • Arlene Fink
    • 1
  • Ronald M. Andersen
    • 4
  • Mark S. Litwin
    • 1
    • 3
    • 4
  1. 1.Department of UrologyDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Department of Family MedicineDavid Geffen School of Medicine at UCLALos AngelesUSA
  3. 3.Jonsson Comprehensive Cancer CenterDavid Geffen School of Medicine at UCLALos AngelesUSA
  4. 4.Department of Health ServicesUCLA School of Public HealthLos AngelesUSA

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