title: The association of diagnosis in the private or NHS sector on prostate cancer stage and treatment.
abstract: BACKGROUND
  To examine associations of private healthcare with stage and management of prostate cancer.
  
  
  METHODS
  Regional population-based cancer registry information on 15 916 prostate cancer patients.
  
  
  RESULTS
  Compared with patients diagnosed in the National Health Service (NHS) (94%), those diagnosed in private hospitals (5%) were significantly more affluent (69 versus 52% in deprivation quintiles 1-2), younger (mean 69 versus 73 years) and diagnosed at earlier stage (72 versus 79% in Stages <III) (P < 0.001 for all). Private hospital of diagnosis was independently associated with lower probability of advanced disease stage [odds ratio (OR) 0.75, P = 0.002], higher probability of surgery use (OR 1.28, P = 0.037) and lower probability of radiotherapy use (OR 0.75, P = 0.001). Private hospital of diagnosis independently predicted higher surgery and lower radiotherapy use, particularly in more deprived patients aged ≤ 70.
  
  
  CONCLUSIONS
  In prostate cancer patients, private hospital diagnosis predicts earlier disease stage, higher use of surgery and lower use of radiotherapy, independently of case-mix differences between the two sectors. Substantial socioeconomic differences in stage and treatment patterns remain across centres in the NHS, even after adjusting for private sector diagnosis. Cancer registration data could be used to identify private care use on a population basis and the potential associated treatment disparities.
authors: Department of Public Health and Primary Care, School of Clinical Medicine,  University of Cambridge, University Forvie Site, Robinson Way, Cambridge CB2 0SR,  UK.
authors: J M
authors: JM
authors: Barbiere
authors: D C
authors: DC
authors: Greenberg
authors: K A
authors: KA
authors: Wright
authors: C H
authors: CH
authors: Brown
authors: C
authors: C
authors: Palmer
authors: D E
authors: DE
authors: Neal
authors: G
authors: G
authors: Lyratzopoulos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D016304:Hospitals, Private / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000473:pathology / Q000628:therapy; D011878:Radiotherapy / Q000706:statistics & numerical data; D012042:Registries; D012959:Socioeconomic Factors; D013222:State Medicine / Q000191:economics / Q000706:statistics & numerical data*; D006113:United Kingdom