Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, University Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.
J Public Health (Oxf). 2012 Mar;34(1):108-14. doi: 10.1093/pubmed/fdr051. Epub 2011 Jul 10.
To examine associations of private healthcare with stage and management of prostate cancer.
Regional population-based cancer registry information on 15 916 prostate cancer patients.
Compared with patients diagnosed in the National Health Service (NHS) (94%), those diagnosed in private hospitals (5%) were significantly more affluent (69 versus 52% in deprivation quintiles 1-2), younger (mean 69 versus 73 years) and diagnosed at earlier stage (72 versus 79% in Stages <III) (P < 0.001 for all). Private hospital of diagnosis was independently associated with lower probability of advanced disease stage [odds ratio (OR) 0.75, P = 0.002], higher probability of surgery use (OR 1.28, P = 0.037) and lower probability of radiotherapy use (OR 0.75, P = 0.001). Private hospital of diagnosis independently predicted higher surgery and lower radiotherapy use, particularly in more deprived patients aged ≤ 70.
In prostate cancer patients, private hospital diagnosis predicts earlier disease stage, higher use of surgery and lower use of radiotherapy, independently of case-mix differences between the two sectors. Substantial socioeconomic differences in stage and treatment patterns remain across centres in the NHS, even after adjusting for private sector diagnosis. Cancer registration data could be used to identify private care use on a population basis and the potential associated treatment disparities.
研究私人医疗保健与前列腺癌分期和治疗的关系。
利用区域人群癌症登记信息，对 15916 名前列腺癌患者进行研究。
与在国民保健制度（NHS）中诊断的患者（94%）相比，在私立医院（5%）诊断的患者明显更富有（贫困五分位数 1-2 中的 69%与 52%），更年轻（平均 69 岁与 73 岁），诊断时处于更早的阶段（<III 期的 72%与 79%）（所有 P<0.001）。诊断私立医院与较低的晚期疾病阶段概率独立相关[比值比（OR）0.75，P=0.002]，手术使用概率更高（OR 1.28，P=0.037），放疗使用概率更低（OR 0.75，P=0.001）。诊断私立医院独立预测了更高的手术和更低的放疗使用概率，尤其是在≤70 岁的较贫困患者中。
在前列腺癌患者中，私立医院的诊断预测了更早的疾病阶段、更高的手术使用率和更低的放疗使用率，独立于两个部门之间的病例组合差异。即使在调整了私营部门诊断后，NHS 内各中心之间在分期和治疗模式方面仍然存在显著的社会经济差异。癌症登记数据可用于基于人群识别私人医疗保健的使用情况以及潜在的相关治疗差异。
