Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population‐based study

• Published in: International journal of cancer Vol. 142; no. 12; pp. 2478 - 2484
• Main Authors: Tomic, Katarina, Ventimiglia, Eugenio, Robinson, David, Häggström, Christel, Lambe, Mats, Stattin, Pär
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 15.06.2018; John Wiley and Sons Inc
• Subjects: Adult; Aged; Aged, 80 and over; Cancer; Cancer Epidemiology; Cancer surgery; cancerepidemiologi; clinical cancer register; Cohort Studies; Demographics; Guidelines; Health risks; Healthcare Disparities; Humans; Male; Medical research; Medicin och hälsovetenskap; Metastases; Middle Aged; Mortality; Odds Ratio; Patients; Population studies; Population-based studies; Prostate cancer; Prostatectomy; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - mortality; Prostatic Neoplasms - therapy; Regression analysis; Social Class; Socioeconomic factors; Socioeconomic status; Socioeconomics; Statistical analysis; Sweden - epidemiology; Sweden; clinical cancer register; socioeconomic status; prostate cancer
• ISSN: 0020-7136; 1097-0215; 1097-0215
• DOI: 10.1002/ijc.31272

Patients with high socioeconomic status (SES) have better cancer outcomes than patients with low SES. This has also been shown in Sweden, a country with tax‐financed health care aiming to provide care on equal terms to all residents. The association between income and educational level and diagnostics and treatment as outlined in national guidelines and prostate cancer (Pca) and all‐cause mortality was assessed in 74,643 men by use of data in the National Prostate Cancer Register of Sweden and a number of other health care registers and demographic databases. In multivariable logistic regression analysis, men with high income had higher probability of Pca detected in a health‐check‐up, top versus bottom income quartile, odds ratio (OR) 1.60 (95% CI 1.45–1.77) and lower probability of waiting more than 3 months for prostatectomy, OR 0.77 (0.69–0.86). Men with the highest incomes also had higher probability of curative treatment for intermediate and high‐risk cancer, OR 1.77 (1.61–1.95) and lower risk of positive margins, (incomplete resection) at prostatectomy, OR 0.80 (0.71–0.90). Similar, but weaker associations were observed for educational level. At 6 years of follow‐up, Pca mortality was modestly lower for men with high income, which was statistically significant for localized high‐risk and metastatic Pca in men with no comorbidities. All‐cause mortality was less than half in top versus bottom quartile of income (12% vs. 30%, p < 0.001) among men above age 65. Our findings underscore the importance of adherence to guidelines to ensure optimal and equal care for all patients diagnosed with cancer. What's new? Even in Sweden, with publicly financed health care, higher socioeconomic status gives people a leg up when it comes to surviving cancer. Why? Here, the authors attempt to tease out associations between income, diagnosis, treatment and mortality. Men with higher incomes, they found, were more likely to have PCa detected in a routine checkup, had shorter wait times for prostatectomy and survived more often. Some of this can be attributed to better general health among wealthier men, but high SES men were also more likely to receive treatment even when the cancer was high risk, and guidelines did not recommend curative treatment.