title: Differences according to socioeconomic status in the management and mortality in men with high risk prostate cancer.
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.
  
  
  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.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. anders.berglund@ki.se
authors.forename: Anders
authors.initials: A
authors.lastname: Berglund
authors.forename: Hans
authors.initials: H
authors.lastname: Garmo
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
authors.forename: Lars
authors.initials: L
authors.lastname: Holmberg
authors.forename: Ola
authors.initials: O
authors.lastname: Bratt
authors.forename: Jan
authors.initials: J
authors.lastname: Adolfsson
authors.forename: Pär
authors.initials: P
authors.lastname: Stattin
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002277:Carcinoma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002423:Cause of Death; D002755:Choice Behavior; D015897:Comorbidity; D003657:Decision Making; D006801:Humans; D007206:Individuality; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D012042:Registries; D012307:Risk Factors; D012923:Social Class; D016019:Survival Analysis