TY - JOUR
T1 - Socioeconomic differences in prostate cancer treatment
T2 - a systematic review and meta-analysis
AU - Gallagher, Benjamin D. T.
AU - Coughlin, Emily C.
AU - Nair-Shalliker, Visalini
AU - McCaffery, Kirsten
AU - Smith, David P.
PY - 2022/8
Y1 - 2022/8
N2 - Background: Since the 1990s, most nations have had a reduction or stabilisation in prostate cancer mortality. However, socioeconomic differences in disease specific mortality and survival have persisted. This has been partially attributed to differences in treatment choices. The aim of this systematic review and meta-analysis was to describe and quantify socioeconomic differences in use of prostate cancer treatment in the literature. Methods: MEDLINE, CINAHL and Embase were searched from 01 January 2000–01 April 2021 to identify articles that reported use of prostate cancer treatment by socioeconomic status. Random effects meta-analysis was used to analyse socioeconomic differences in treatment where there was more than one study for treatment type. A modified version of the Newcastle-Ottawa Scale was used to assess risk of bias. Results: Out of 7267 articles identified, eight met the inclusion criteria and six were analysed using meta-analysis. Meta-analysis could only be completed for non-active treatment (watchful waiting/active surveillance). Lower education was associated with non-active treatment (OR=0.90, [95% CI 0.83–0.98], p=0.02, I2=67%), however, level of income was not (OR=0.87, [CI 0.75–1.02], p=0.08, I2=94%). Sensitivity analysis of studies where active surveillance was the outcome (n=3), indicated no associations with level of income (OR=0.91, [95% CI 0.82–1.01], p=0.08, I2=52%) or education (OR=0.88, [95% CI 0.70–1.10], p=0.25, I2=79%). All studies were assessed as high-risk of bias. Discussion: The relationship between socioeconomic status and prostate cancer treatment depended on the socioeconomic variable being used, the treatment type and how it was defined in research. Considerable methodological limitations were identified. Further research should improve on previous findings and address current gaps.
AB - Background: Since the 1990s, most nations have had a reduction or stabilisation in prostate cancer mortality. However, socioeconomic differences in disease specific mortality and survival have persisted. This has been partially attributed to differences in treatment choices. The aim of this systematic review and meta-analysis was to describe and quantify socioeconomic differences in use of prostate cancer treatment in the literature. Methods: MEDLINE, CINAHL and Embase were searched from 01 January 2000–01 April 2021 to identify articles that reported use of prostate cancer treatment by socioeconomic status. Random effects meta-analysis was used to analyse socioeconomic differences in treatment where there was more than one study for treatment type. A modified version of the Newcastle-Ottawa Scale was used to assess risk of bias. Results: Out of 7267 articles identified, eight met the inclusion criteria and six were analysed using meta-analysis. Meta-analysis could only be completed for non-active treatment (watchful waiting/active surveillance). Lower education was associated with non-active treatment (OR=0.90, [95% CI 0.83–0.98], p=0.02, I2=67%), however, level of income was not (OR=0.87, [CI 0.75–1.02], p=0.08, I2=94%). Sensitivity analysis of studies where active surveillance was the outcome (n=3), indicated no associations with level of income (OR=0.91, [95% CI 0.82–1.01], p=0.08, I2=52%) or education (OR=0.88, [95% CI 0.70–1.10], p=0.25, I2=79%). All studies were assessed as high-risk of bias. Discussion: The relationship between socioeconomic status and prostate cancer treatment depended on the socioeconomic variable being used, the treatment type and how it was defined in research. Considerable methodological limitations were identified. Further research should improve on previous findings and address current gaps.
KW - Conservative treatment
KW - Prostatectomy
KW - Prostatic neoplasms
KW - Radiotherapy
KW - Socioeconomic factors
UR - http://www.scopus.com/inward/record.url?scp=85129697659&partnerID=8YFLogxK
U2 - 10.1016/j.canep.2022.102164
DO - 10.1016/j.canep.2022.102164
M3 - Review article
C2 - 35526516
AN - SCOPUS:85129697659
SN - 1877-7821
VL - 79
SP - 1
EP - 11
JO - Cancer Epidemiology
JF - Cancer Epidemiology
M1 - 102164
ER -