Socioeconomic status and prostate cancer risk


We may tend to think that the European nations, with their varied types of “nationalized” health care system, have overcome the economic health care disparities so evident in nations like the USA, where the ability of pay for and obtain high quality insurance coverage has major impact on access to health care. However, a recent study of the impact of socioeconomic status on prostate cancer presentation, treatment, and prognosis in Geneva, Switzerland, should rapidly disabuse us of any such assumptions.

Switzerland in general (and arguably Geneva in particular) would be considered to be a nation and region (a Swiss “canton”) in which medical coverage and life expectancy are considered to be among the highest in the world — but so are health-care costs.

Rapiti et al. studied the available data on all patients diagnosed with invasive prostate cancer among the resident population of Geneva between 1995 and 2005. They divided the patients into three socioeconomic groups based on their last known occupation. They then sought to evaluate the impact of socioeconomic status on prostate cancer diagnosis, management, and outcomes over time.

The results of their study showed that, by comparison to patients of high socioeconomic status, those of low socioeconomic class were:

  • More commonly foreigners
  • Less likely to have screen-detected cancer
  • More likely to have a more advanced stage of disease at diagnosis
  • Less commonly had relevant information regarding disease characteristics and staging
  • Less likely to receive prostatectomy as their primary treatment
  • More often managed with watchful waiting.
  • Twice as likely to die as a consequence of their prostate cancer.

It should be noted that after adjustment for patient and tumor characteristics and treatment, the relative mortality risk of low compared to high socioeconomic status was no longer found to be significantly increased, and the authors conclude that the increased risk for mortality observed in this study is largely attributable to delayed diagnosis, poor diagnostic workup, and less invasive treatments in patients of low socioeconomic status.

This study emphasizes the impact of low socioeconomic status on prostate cancer risk — even in nations with a sophisticated national health care system where (at least in theory) everyone should be receiving the same level of care. Whether the problem is educational, motivational, cultural, or economic at the core, what is apparent is that greater efforts are needed to ensure that men of low socioeconomic status get comparable quality of care to their brethren of high socioeconomic status (always assuming that this is a social and moral priority).

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