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Differences according to socioeconomic status in the management and mortality in men with high risk prostate cancer
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Endokrinkirurgi.
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2012 (Engelska)Ingår i: European Journal of Cancer, ISSN 0959-8049, E-ISSN 1879-0852, Vol. 48, nr 1, s. 75-84Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

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 20-50ng/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.

Ort, förlag, år, upplaga, sidor
2012. Vol. 48, nr 1, s. 75-84
Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
URN: urn:nbn:se:uu:diva-166018DOI: 10.1016/j.ejca.2011.07.009ISI: 000299866200010PubMedID: 21852113OAI: oai:DiVA.org:uu-166018DiVA, id: diva2:475063
Tillgänglig från: 2012-01-10 Skapad: 2012-01-10 Senast uppdaterad: 2017-12-08Bibliografiskt granskad

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