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Socioeconomic status and diagnosis, treatment, and mortality in men with prostate cancer. Nationwide population-based study
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Urology and Andrology.ORCID iD: 0000-0001-6958-5930
Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.
Department of Urology, Ryhov Hospital, Jönköping, Sweden .
Umeå University, Faculty of Medicine, Department of Biobank Research. Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.ORCID iD: 0000-0001-6808-4405
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2018 (English)In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215Article in journal (Refereed) Epub ahead of print
Abstract [en]

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.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018.
Keyword [en]
clinical cancer register, prostate cancer, socioeconomic status
National Category
Urology and Nephrology
Research subject
Cancer Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-144548DOI: 10.1002/ijc.31272PubMedID: 29363113OAI: oai:DiVA.org:umu-144548DiVA: diva2:1180598
Funder
Swedish Research Council, 2012-5047Swedish Cancer Society, 2016-0700
Available from: 2018-02-06 Created: 2018-02-06 Last updated: 2018-02-06Bibliographically approved
In thesis
1. Data quality in the National Prostate Cancer Register (NPCR) of Sweden
Open this publication in new window or tab >>Data quality in the National Prostate Cancer Register (NPCR) of Sweden
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Data in quality registers are increasingly used for quality assurance of health care, benchmarking, and research. If valid conclusions are to be drawn from such studies, it is vital that register data have high quality. The aim of this thesis was to assess data quality in the National Prostate Cancer Register (NPCR) of Sweden, a nationwide register that since 1998 captures 98% of all cases of Prostate cancer (Pca) in Sweden. The proportion and characteristics of Pca cases not registered in NPCR was investigated in paper I. Four dimensions of data quality were evaluated for NPCR in paper II: completeness, timeliness, comparability, and validity. Proportion and characteristics of Pca cases registered in NPCR but with unknown risk category were investigated in paper III. Finally, the association between Socioeconomic Status (SES) and Pca diagnosis, treatment, and mortality was studied in paper IV. 

Material and methods: Data quality of NPCR was studied by cross-linkages between NPCR and other health care registers and demographical databases by use of the Swedish personal identity number. Validity was further studied by re-abstraction of patient health care records, followed by comparison of re-abstracted and original register data.

Results: Men not registered in NPCR, who constituted around 2% of all cases in the Swedish Cancer Register, differed only modestly in characteristics from cases in NPCR, indicating that NPCR is generalizable for all men with Pca in Sweden. Data quality in NPCR was high overall, with high completeness compared to the Swedish Cancer Register with registration mandated by law and few Pca cases were detected by use of death certificates. There was timely registration, and good comparability with registration forms and coding routines that were compliant with international guidelines. Data validity was high with high agreement and correlation for key variables. Men with unknown risk category had, compared to men with known risk category, more often concomitant bladder cancer, higher comorbidity, and lower Pca mortality. Men with high SES had, compared to men with low SES, higher probability of Pca detected during health checkup, shorter waiting times for prostatectomy, and higher probability of curative treatment for intermediate and high-risk cancer. Pca mortality was lower in men with high SES than in men with low SES for high-risk cancer.

Conclusion: These results indicate that data quality in NPCR is high and that NPCR is population-based. There were consistent differences in diagnostic and therapeutic activity according to SES despite an equal access tax-financed healthcare system in Sweden. 

Place, publisher, year, edition, pages
Umeå: Umeå University, 2018. p. 44
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1945
Keyword
Prostate cancer, Cancer quality register, Data quality, Evaluation, Validity
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-144553 (URN)978-91-7601-831-6 (ISBN)
Public defence
2018-03-02, E04, Farmakologihuset, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Research Council, 2012-5047Swedish Cancer Society, 2016-0700
Available from: 2018-02-09 Created: 2018-02-06 Last updated: 2018-02-07Bibliographically approved

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