Abstract
Objective: To identify possible causes for inequitable prostate cancer (PCa) outcomes in Māori by examining any differences in the assessment and management of Māori and non-Māori diagnosed with PCa in Aotearoa New Zealand (NZ).
Patients and methods: The study was a retrospective cohort study of 13 893 men (1155 Māori and 12 828 non-Māori) with PCa between 1 January 2016 and 30 June 2022 who were recruited from the New Zealand Prostate Cancer Outcome Registry (PCOR-NZ), a national registry for collating PCa care and outcomes data. Data linkage with the National Minimum Dataset, a NZ Ministry of Health database, was performed to gather socioeconomic and comorbidity data. Multivariate regression analyses were performed to assess between-group differences in PCa care controlling for confounders.
Results: Māori were found to be diagnosed with PCa younger and with more aggressive disease than non-Māori. At disease presentation, Māori were more likely to receive transrectal ultrasound-guided prostate biopsy but less likely to receive transperineal prostate biopsy compared to non-Māori. Compared to non-Māori, a larger proportion of Māori received computed tomography and bone scans but not positron emission tomography scans for PCa staging. For PCa treatment, Māori were more likely to receive radiotherapy and hormonal therapy but less likely to receive surgery than non-Māori. Variation in PCa assessment and treatment between Māori and non-Māori persisted after adjusting for confounders (P < 0.005).
Conclusion: Variations in PCa assessment and treatment between Māori and non-Māori are evident in NZ. Ongoing data collection through population-based registries would need to be continued to monitor effectiveness of interventions aimed at reducing ethnic variances in PCa care in NZ.