Association of sociodemographic and clinical variables with time to start prostate cancer treatment

Sacramento, Raone Silva; Simião, Luana de Jesus; Viana, Kátia Cirlene Gomes; Andrade, Maria Angélica Carvalho; Amorim, Maria Helena Costa; Zandonade, Eliana

doi:10.1590/1413-81232018249.31142017

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ARTICLE • Ciênc. saúde coletiva 24 (9) • Sept 2019 • https://doi.org/10.1590/1413-81232018249.31142017 copy

Association of sociodemographic and clinical variables with time to start prostate cancer treatment

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: Disparities in prostate cancer care have been evidenced and associated with sociodemographic and clinical factors, which establish the time for diagnosis and initiation of treatment. Objective: To evaluate the association of sociodemographic and clinical variables with the onset of prostate cancer treatment. Methods: This is a prospective longitudinal cohort study with secondary data with a population of men with prostate cancer attended in the periods 2010-2011 and 2013-2014 at the Santa Rita de Cássia Hospital in Vitória, Espírito Santo, Brazil. Results: The study population consisted of 1,388 men. Of the total, those younger than 70 years (OR = 1.85; CI = 1.49-2.31), nonwhite (OR = 1.30; CI = 1.00-1.70), less than 8 years of schooling (OR = 1.52; CI = 1.06-2.17) and referred by the Unified Health System services (OR = 2.52; CI = 1.84-3.46) were more likely to have a delayed treatment. Similarly, the lower the Gleason score (OR = 1.78; CI = 1.37-2.32) and Prostate-Specific Antigens levels (OR = 2.71; CI = 2.07-3.54), the greater the likelihood of delay for the onset of treatment. Conclusion: Therefore, sociodemographic and clinical characteristics exerted a strong influence on the access to prostate cancer treatment.

Keywords
Health services accessibility; Health equity; Time-to-treatment; Prostatic neoplasms

Variables	Time between diagnosis and onset of treatment					Time between first consultation and onset of treatment
	Under 60 days		60 days and over			Under 60 days		60 days and over
	N	%	N	%	p-value	N	%	N	%	p-value
Age
Under 70 years	111	14%	661	86%	0.062	310	40%	462	60%	0.001
71 years and over	105	18%	474	82%		321	55%	258	45%
Age group
Under 54 years	13	15%	76	85%	0.088	32	36%	57	64%	0.001
55-59 years	14	12%	99	88%		50	44%	63	56%
60-64 years	26	12%	188	88%		79	37%	135	63%
65-69 years	49	16%	252	84%		135	45%	166	55%
70-74 years	36	14%	223	86%		112	43%	147	57%
75-79 years	46	20%	181	80%		136	60%	91	40%
80 years and over	32	22%	116	78%		87	59%	61	41%
Skin color / ethnicity
White	46	16%	238	84%	0.865	146	51%	138	49%	0.050
Non white	157	16%	838	84%		446	45%	549	55%
Years of schooling
Under 8 years	158	16%	847	84%	0.027	464	46%	541	54%	0.022
9 years and over	32	23%	106	77%		78	57%	60	43%
Law of 60 days
Before the Law	109	16%	584	84%	0.789	345	50%	348	50%	0.020
After the Law	107	16%	551	84%		286	43%	372	57%
Previous diagnosis
No diagnosis and no treatment	58	32%	125	68%	0.001	18	10%	165	90%	0.001
With diagnosis and no treatment	158	14%	1010	86%		613	52%	555	48%
Referral origin
SUS	111	12%	787	88%	0.001	386	43%	512	57%	0.001
Non SUS	58	28%	148	72%		135	66%	71	34%

Variables	Time between diagnosis and onset of treatment					Time between first consultation and onset of treatment
	Under 60 days		60 days and over			Under 60 days		60 days and over
	N	%	N	%	p-value	N	%	N	%	p-value
Staging
1	7	9%	68	91%	0.001	29	39%	46	61%	0.001
2	28	10%	244	90%		118	43%	154	57%
3	16	18%	71	82%		44	51%	43	49%
4	57	40%	87	60%		92	64%	52	36%
Gleason score
2-6	58	9%	557	91%	0.001	246	40%	369	60%	0.001
7	54	15%	316	85%		180	49%	190	51%
8-10	97	28%	253	72%		190	54%	160	46%
PSA
Less than 10	51	10%	478	90%	0.001	198	37%	331	63%	0.001
10-19	34	11%	265	89%		132	44%	167	56%
20 and over	116	29%	282	71%		246	62%	152	38%

Categories	Time between diagnosis and first consultation > 60 days
	Odds Crude				Odds Adjusted
	p-value	OR	LL 95%	UL 95%	p-value	OR	LL 95%	UL 95%
Age
Under 70 years	0.063	1.32	0.99	1.77
71 years and over		1.00
Age group
Under 54 years	0.185	1.61	0.80	3.27	0.793	1.15	0.40	3.28
55-59 years	0.055	1.95	0.99	3.86	0.325	1.65	0.61	4.48
60-64 years	0.017	1.99	1.13	3.52	0.655	1.19	0.55	2.57
65-69 years	0.168	1.42	0.86	2.33	0.551	0.81	0.41	1.62
70-74 years	0.046	1.71	1.01	2.89	0.163	1.68	0.81	3.47
75-79 years	0.752	1.09	0.65	1.80	0.562	0.81	0.40	1.64
80 years and over		1.00				1.00
Years of schooling
Under 8 years	0.028	1.62	1.05	2.49	0.065	1.70	0.97	3.00
9 years and over		1.00				1.00
Previous diagnosis
No diagnosis and no treatment		1.00				1.00
With diagnosis and no treatment	0.001	2.97	2.08	4.22	0.001	3.08	1.79	5.29
Referral origin
SUS	0.001	2.78	1.93	3.99	0.001	2.45	1.56	3.85
Non SUS		1.00				1.00
Gleason score
2-6	0.001	3.68	2.57	5.27	0.001	2.59	1.55	4.32
7	0.001	2.24	1.55	3.25	0.098	1.51	0.93	2.47
8-10		1.00				1.00
PSA
Less than 10	0.001	3.86	2.69	5.53	0.001	4.42	2.59	7.54
10-19	0.001	3.21	2.11	4.87	0.007	2.02	1.22	3.37
20 and over		1.00				1.00

Variables	Time between first consultation and onset of treatment > 60 days
	Odds Crude				Odds Adjusted
	p-value	OR	LL 95%	UL 95%	p-value	OR	LL 95%	UL 95%
Age
Under 70 years	0.001	1.85	1.49	2.31
71 years and over		1.00
Age group
Under 54 years	0.001	2.54	1.48	4.37	0.025	2.59	1.13	5.96
55-59 years	0.020	1.80	1.10	2.95	0.021	2.40	1.14	5.05
60-64 years	0.001	2.44	1.59	3.74	0.014	2.22	1.18	4.18
65-69 years	0.006	1.75	1.18	2.61	0.053	1.81	0.99	3.32
70-74 years	0.003	1.87	1.24	2.82	0.086	1.71	0.93	3.16
75-79 years	0.828	0.95	0.63	1.45	0.665	0.87	0.45	1.66
80 years and over		1.00				1.00
Skin color / ethnicity
White		1.00				1.00
Non white	0.050	1.30	1.00	1.70	0.052	1.45	1.00	2.11
Years of schooling
Under 8 years	0.023	1.52	1.06	2.17	0.008	2.04	1.20	3.48
9 years and over		1.00				1.00
Law of 60 days
Before the Law		1.00				1.00
After the Law	0.020	1.29	1.04	1.60	0.199	1.23	0.90	1.68
Previous diagnosis
No diagnosis and no treatment		1.00				1.00
With diagnosis and no treatment	0.001	0.10	0.06	0.16	0.001	0.03	0.01	0.09
Referral origin
SUS	0.001	2.52	1.84	3.46	0.001	2.26	1.49	3.44
Non SUS		1.00				1.00
Gleason score
2-6	0.000	1.78	1.37	2.32	0.032	1.58	1.04	2.40
7	0.131	1.25	0.94	1.68	0.074	1.49	0.96	2.31
8-10		1.00
PSA
Less than 10	0.001	2.71	2.07	3.54	0.001	2.38	1.60	3.54
10-19	0.001	2.05	1.51	2.78	0.001	2.18	1.43	3.33
20 and over		1.00

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[1] Collaborations

RS Sacramento, LJ Simião, KCG Viana, MAC Andrade, MHC Amorim and E Zandonade participated in the different parts of the article.