Disparities/Minority Health

Elderly black men are less likely than white men to seek and receive care for lower urinary tract symptoms

Lower urinary tract symptoms (LUTS) are very common among aging men. This is often due to an enlarged prostate, which presses on the urethra, making it difficult or painful to urinate. Elderly black men are more likely to delay seeking care until their symptoms interfere with daily activities, and they are less likely to have ever had or to have regular digital rectal exams (DREs) that can detect an enlarged prostate, according to a new study.

Daniel L. Howard, Ph.D., of the Institute for Health, Social, and Community Research, and colleagues examined health care seeking behavior for LUTS among black and white elderly men in five North Carolina counties. They analyzed responses of 889 male respondents from a 1994 survey, a group that had declined to 471 respondents by the 1998 survey.

In 1994, 49.4 percent of blacks sought care for LUTS compared with 56.8 percent of whites. By 1998, these percentages increased to 60.6 percent and 70.3 percent, respectively. Also, by 1998, blacks' LUTS continued to cause them more moderate to severe interference in daily activities than whites' LUTS. Yet in both years, black elders were more likely to receive care in a public clinic/hospital or emergency room than a physician's office.

There is no reason to think the biology of the prostate is different among ethnic groups. However, the threshold at which blacks and whites perceive a symptom to be a problem may be different. For example, more blacks than whites reported that their LUTS interfered with daily activities. Yet blacks were not as bothered by LUTS as whites. In this study, access to care and poor health behavior had the greatest impact on health care seeking and receipt of diagnostic care for LUTS. More studies are needed on factors underlying undertreatment of LUTS among black elders.

The study was supported in part by the Agency for Healthcare Research and Quality (HS13353).

See "Healthcare practices among blacks and whites with urinary tract symptoms," by Dr. Howard, Bennett G. Edwards, Ph.D., Kimberly Whitehead, Ph.D., and others, in the April 2007 Journal of the National Medical Association 99(4), pp. 404-411.

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