Penson D F, Stoddard M L, Pasta D J, Lubeck D P, Flanders S C, Litwin M S
Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
J Clin Epidemiol. 2001 Apr;54(4):350-8. doi: 10.1016/s0895-4356(00)00312-7.
The objective of this study was to examine the effect of socioeconomic status and insurance status on health-related quality of life (HRQOL) outcomes in men with prostate cancer. The design was a retrospective cohort study using multiple sites, including both academic and private practice settings. A cohort of 860 men with newly diagnosed, biopsy-proven prostate cancer of any stage was identified within CaPSURE, a longitudinal disease registry of prostate cancer patients. HRQOL was assessed with validated instruments, including the RAND 36-item Health Survey (SF-36) and the UCLA Prostate Cancer Index. Covariates included insurance status, education level, annual income, age, stage, comorbidity, Gleason grade, baseline PSA, marital status, ethnicity and primary treatment. HRQOL measurements were taken at 3-6-month intervals. Analysis of covariance was used to determine the effect of SES and insurance status on the HRQOL domains at baseline and over time. Patients with lower annual income had significantly lower baseline HRQOL scores in the all of the domains of the SF-36 and four of eight disease-specific HRQOL domains. No relationship was seen between annual income and HRQOL outcomes over time. Conversely, health insurance status was associated with HRQOL over time, but not at baseline. Health insurance status appears to have a unique effect on general HRQOL outcomes in men after treatment for prostate cancer. This study confirms the commonly held belief that patients of lower SES tend to have worse quality of life at baseline and following treatment for their disease. These findings have important ramifications for clinicians, researchers and policy makers.
本研究的目的是检验社会经济地位和保险状况对前列腺癌男性患者健康相关生活质量（HRQOL）结果的影响。研究设计为一项回顾性队列研究，使用了多个地点，包括学术机构和私人诊所。在CaPSURE（一个前列腺癌患者纵向疾病登记处）中确定了一组860名新诊断的、经活检证实为任何阶段前列腺癌的男性。使用经过验证的工具评估HRQOL，包括兰德36项健康调查（SF - 36）和加州大学洛杉矶分校前列腺癌指数。协变量包括保险状况、教育水平、年收入、年龄、分期、合并症、 Gleason分级、基线前列腺特异抗原（PSA）、婚姻状况、种族和主要治疗方法。HRQOL测量每隔3 - 6个月进行一次。协方差分析用于确定社会经济地位（SES）和保险状况在基线和随时间变化对HRQOL领域的影响。年收入较低的患者在SF - 36的所有领域以及八个疾病特异性HRQOL领域中的四个领域的基线HRQOL得分显著较低。随时间推移，未发现年收入与HRQOL结果之间存在关系。相反，医疗保险状况与随时间变化的HRQOL相关，但在基线时不相关。医疗保险状况似乎对前列腺癌治疗后的男性总体HRQOL结果有独特影响。本研究证实了普遍持有的观点，即社会经济地位较低的患者在基线时以及疾病治疗后往往生活质量较差。这些发现对临床医生、研究人员和政策制定者具有重要影响。
