title: Socioeconomic disadvantage but not remoteness affects short-term survival in prostate cancer: A population-based study using competing risks.
abstract: OBJECTIVE
  We examined how sociodemographic, clinical and area-level factors are related to short-term prostate cancer mortality versus mortality from other causes, a crucial distinction for this disease that disproportionately affects men older than 60 years.
  
  
  METHODS
  We applied competing risk survival models to administrative data from the Queensland Cancer Registry (Australia) for men diagnosed with prostate cancer between January 2005 and July 2007, including stratification by Gleason score.
  
  
  RESULTS
  The men (n = 7393) in the study cohort had a median follow-up of 5 years 3 months. After adjustment, remoteness and area-level disadvantage were not significantly associated with prostate cancer mortality. However, area-level disadvantage had a significant negative relationship with hazard of death from a cause other than prostate cancer within 7 years; compared with those living in the most advantaged areas, the likelihood of mortality was higher for those in the most disadvantaged (subhazard ratio [SHR] = 1.39; 95% CI, 1.01-1.90; P = 0.041), disadvantaged (SHR = 1.51; 95% CI, 1.14-2.00; P = 0.004), middle (SHR = 1.34; 95% CI, 1.02-1.75; P = 0.034) and advantaged areas (SHR = 1.44; 95% CI, 1.09-1.89; P = 0.009). Those with Gleason score of 7 and higher had a lower hazard of prostate cancer mortality if they were living with a partner, whereas those with lower Gleason scores and living a partner had lower hazards of other-cause mortality.
  
  
  CONCLUSIONS
  Understanding why men living in more disadvantaged areas have higher risk of non-prostate cancer mortality should be a priority.
authors: Health Promotion Research Centre, National University of Ireland, Galway, Ireland.
authors: Audrey A
authors: AA
authors: Thomas
authors: National Cancer Registry, Ireland.
authors: Alison
authors: A
authors: Pearce
authors: Institute of Health and Society, Newcastle University, United Kingdom.
authors: Linda
authors: L
authors: Sharp
authors: School of Medicine University of Queensland, Australia.
authors: Robert Alexander
authors: RA
authors: Gardiner
authors: Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.
authors: Suzanne
authors: S
authors: Chambers
authors: Cancer Council Queensland, Brisbane, Australia.
authors: Joanne
authors: J
authors: Aitken
authors: Department of Health Promotion, National University of Ireland, Galway, Ireland.
authors: Michal
authors: M
authors: Molcho
authors: Cancer Council Queensland, Brisbane, Australia.
authors: Peter
authors: P
authors: Baade
mesh_terms: D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011471:Prostatic Neoplasms / Q000191:economics / Q000401:mortality* / Q000473:pathology; D011793:Queensland / Q000453:epidemiology; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012923:Social Class; D012959:Socioeconomic Factors
keywords: Cause of death; follow-up studies; prostate cancer; socioeconomic factors; survival analysis