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Differences according to socioeconomic status in the management and mortality in men with high risk prostate cancer

Berglund, Anders; Garmo, Hans; Robinson, David; Tishelman, Carol; Holmberg, Lars; Bratt, Ola LU ; Adolfsson, Jan; Stattin, Par and Lambe, Mats (2012) In European Journal of Cancer 48(1). p.75-84
Abstract
Background: Outcomes for many cancer forms are associated with socioeconomic status (SES). We investigated if SES was associated with management and mortality in men with high risk prostate cancer. Material and methods: A nation-wide population-based cohort in Prostate Cancer Data Base Sweden (PCBaSe), a merged database including data on incident prostate cancer identified in the National Prostate Cancer Register (NPCR) between 1997 and 2006. High risk PCa was defined as T3 tumour, and/or Gleason score 8-10 and/or PSA 20-50 ng/mL. Use of bone scan, curative treatment, and mortality in relation to SES was assessed by logistic, Cox, and competing risk regression with hazard ratios (HR), sub-distributed HR and 95% confidence intervals (CI)... (More)
Background: Outcomes for many cancer forms are associated with socioeconomic status (SES). We investigated if SES was associated with management and mortality in men with high risk prostate cancer. Material and methods: A nation-wide population-based cohort in Prostate Cancer Data Base Sweden (PCBaSe), a merged database including data on incident prostate cancer identified in the National Prostate Cancer Register (NPCR) between 1997 and 2006. High risk PCa was defined as T3 tumour, and/or Gleason score 8-10 and/or PSA 20-50 ng/mL. Use of bone scan, curative treatment, and mortality in relation to SES was assessed by logistic, Cox, and competing risk regression with hazard ratios (HR), sub-distributed HR and 95% confidence intervals (CI) adjusted for co-morbidity, age, calendar period and clinical subgroups. Results: Amongst 17,522 high risk prostate cancer patients, a bone scan was more often performed in higher white-collar than in blue-collar workers (OR 1.30; 95% CI 1.21-1.40). Amongst men without metastases, the likelihood of intention to treat was higher in higher white-collar workers (OR 1.43; 95% CI 1.28-1.57). In men who received curative treatment, the likelihood was higher to undergo radical prostatectomy for higher white-collar patients (OR 1.29; 95% CI 1.10-1.47). In men without metastases, not only overall mortality was lower amongst higher white-collar workers (HR, 0.76; 95% CI 0.60-0.97), but also prostate cancer-specific mortality (sHR 0.70; 95% CI, 0.49-0.99). Conclusions: We conclude that socioeconomic disparities in the management and mortality in men with high risk prostate cancer exist also within the setting of a National Health Care System aiming to provide care on equal terms to all residents. (C) 2011 Elsevier Ltd. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Diagnostic intensity, High risk prostatic neoplasm, Mortality, Socioeconomic status, Treatment, Sweden
in
European Journal of Cancer
volume
48
issue
1
pages
75 - 84
publisher
IFAC & Elsevier Ltd.
external identifiers
  • wos:000299866200010
  • scopus:83255185160
ISSN
1879-0852
DOI
10.1016/j.ejca.2011.07.009
language
English
LU publication?
yes
id
1d4854d0-2fc2-4c2e-82ec-5d4b0ba8e347 (old id 2425506)
date added to LUP
2012-04-02 09:54:10
date last changed
2017-06-18 03:16:35
@article{1d4854d0-2fc2-4c2e-82ec-5d4b0ba8e347,
  abstract     = {Background: Outcomes for many cancer forms are associated with socioeconomic status (SES). We investigated if SES was associated with management and mortality in men with high risk prostate cancer. Material and methods: A nation-wide population-based cohort in Prostate Cancer Data Base Sweden (PCBaSe), a merged database including data on incident prostate cancer identified in the National Prostate Cancer Register (NPCR) between 1997 and 2006. High risk PCa was defined as T3 tumour, and/or Gleason score 8-10 and/or PSA 20-50 ng/mL. Use of bone scan, curative treatment, and mortality in relation to SES was assessed by logistic, Cox, and competing risk regression with hazard ratios (HR), sub-distributed HR and 95% confidence intervals (CI) adjusted for co-morbidity, age, calendar period and clinical subgroups. Results: Amongst 17,522 high risk prostate cancer patients, a bone scan was more often performed in higher white-collar than in blue-collar workers (OR 1.30; 95% CI 1.21-1.40). Amongst men without metastases, the likelihood of intention to treat was higher in higher white-collar workers (OR 1.43; 95% CI 1.28-1.57). In men who received curative treatment, the likelihood was higher to undergo radical prostatectomy for higher white-collar patients (OR 1.29; 95% CI 1.10-1.47). In men without metastases, not only overall mortality was lower amongst higher white-collar workers (HR, 0.76; 95% CI 0.60-0.97), but also prostate cancer-specific mortality (sHR 0.70; 95% CI, 0.49-0.99). Conclusions: We conclude that socioeconomic disparities in the management and mortality in men with high risk prostate cancer exist also within the setting of a National Health Care System aiming to provide care on equal terms to all residents. (C) 2011 Elsevier Ltd. All rights reserved.},
  author       = {Berglund, Anders and Garmo, Hans and Robinson, David and Tishelman, Carol and Holmberg, Lars and Bratt, Ola and Adolfsson, Jan and Stattin, Par and Lambe, Mats},
  issn         = {1879-0852},
  keyword      = {Diagnostic intensity,High risk prostatic neoplasm,Mortality,Socioeconomic status,Treatment,Sweden},
  language     = {eng},
  number       = {1},
  pages        = {75--84},
  publisher    = {IFAC & Elsevier Ltd.},
  series       = {European Journal of Cancer},
  title        = {Differences according to socioeconomic status in the management and mortality in men with high risk prostate cancer},
  url          = {http://dx.doi.org/10.1016/j.ejca.2011.07.009},
  volume       = {48},
  year         = {2012},
}