Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, NSW, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia.
Department of Medical Education, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States.
Cancer Epidemiol. 2022 Aug;79:102164. doi: 10.1016/j.canep.2022.102164. Epub 2022 May 6.
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.
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.
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, I=67%), however, level of income was not (OR=0.87, [CI 0.75-1.02], p=0.08, I=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, I=52%) or education (OR=0.88, [95% CI 0.70-1.10], p=0.25, I=79%). All studies were assessed as high-risk of bias.
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.
自 20 世纪 90 年代以来，大多数国家的前列腺癌死亡率都有所下降或趋于稳定。然而，疾病特异性死亡率和生存率方面的社会经济差异仍然存在。这在一定程度上归因于治疗选择的差异。本系统评价和荟萃分析的目的是描述和量化文献中前列腺癌治疗的社会经济差异。
从 2000 年 1 月 1 日至 2021 年 4 月 1 日，检索 MEDLINE、CINAHL 和 Embase，以确定报告按社会经济地位使用前列腺癌治疗的文章。对于有多种治疗类型的研究，采用随机效应荟萃分析分析治疗中的社会经济差异。使用纽卡斯尔-渥太华量表的修改版评估偏倚风险。
在 7267 篇文章中，有 8 篇符合纳入标准，其中 6 篇使用荟萃分析进行了分析。仅可对非积极治疗（观察等待/主动监测）进行荟萃分析。较低的教育程度与非积极治疗相关（OR=0.90，[95%CI 0.83-0.98]，p=0.02，I=67%），但收入水平则不然（OR=0.87，[CI 0.75-1.02]，p=0.08，I=94%）。对以主动监测为结局的研究（n=3）进行敏感性分析，结果表明，收入水平（OR=0.91，[95%CI 0.82-1.01]，p=0.08，I=52%）或教育程度（OR=0.88，[95%CI 0.70-1.10]，p=0.25，I=79%）与治疗之间均无关联。所有研究均被评估为高偏倚风险。
社会经济地位与前列腺癌治疗之间的关系取决于所使用的社会经济变量、治疗类型以及研究中对其的定义。本研究确定了相当多的方法学局限性。应开展进一步的研究以改进先前的发现并解决当前的差距。
