title: Socioeconomic factors and penile cancer risk and mortality; a population-based study.
abstract: OBJECTIVE
  To investigate possible associations between socioeconomic status (SES) and penile cancer risk, stage at diagnosis, and mortality.
  
  
  METHODS
  A population-based register study including men in Sweden diagnosed with penile cancer between 2000 and 2012 (1676 men) and randomly chosen controls (9872 men). Data were retrieved from the National Penile Cancer Register (NPECR) and several other population-based healthcare and sociodemographic registers. Educational level, disposable income, marital status, and number of individuals in the household, were assessed as indicators of SES. The risk of penile cancer and penile cancer death in relation to SES were estimated using logistic regression and proportional hazards models, respectively. Cumulative cause-specific mortality (CSM) estimates by SES were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  A low educational level and low disposable income were associated with an increased risk of invasive penile cancer. Furthermore, low educational level was associated with more advanced primary tumour stage. Divorced and never married men had a generally increased risk of penile cancer and were diagnosed with more advanced primary tumour stages. However, neither educational level nor marital status was associated with lymph node or distant metastases. Also, men in single-person households had an increased risk of both non-invasive and invasive disease. In men with invasive penile cancer, there were no significant associations of indicators of SES and CSM.
  
  
  CONCLUSIONS
  Low educational level, low disposable income, being divorced or never married, and living in a single-person household, all increase the risk of advanced stage penile cancer, but not lymph node or distant metastases. The assessed indicators of SES did not influence penile CSM. In conclusion, our findings indicates that SES influences the risk and stage of penile cancer, but not survival.
authors.affiliation: Department of Urology, Skåne University Hospital, Malmö, Sweden.|Department of Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Torbrand
authors.affiliation: Regional Cancer Centre Uppsala-Örebro, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Annette
authors.initials: A
authors.lastname: Wigertz
authors.affiliation: Regional Cancer Centre Uppsala-Örebro, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Drevin
authors.affiliation: Regional Cancer Centre Uppsala-Örebro, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Yasin
authors.initials: Y
authors.lastname: Folkvaljon
authors.affiliation: Regional Cancer Centre Uppsala-Örebro, Uppsala University Hospital, Uppsala, Sweden.|Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Lambe
authors.affiliation: Department of Urology, Skåne University Hospital, Malmö, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Håkansson
authors.affiliation: Department of Urology, Örebro University Hospital, Örebro, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Kirrander
mesh_terms: D000368:Aged; D002423:Cause of Death; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010412:Penile Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D012306:Risk; D012959:Socioeconomic Factors
keywords: educational level; marital status; mortality; penile cancer; risk; socioeconomic status