Disparities in prostate cancer treatment selection in the state of Florida: The impact of socioeconomic status and education level

Background: Disparities exist in the initial treatment selected by a patient and his provider for the treatment of localized prostate cancer (LPC). The objective of this study was to examine the impact of socioeconomic status (SES) and education level (EL) on initial treatment selection of LPC after controlling for sociodemographic and clinical factors. Methods: The Florida Cancer Data System was used to obtain data (n=85,062) from men diagnosed with LPC between 2001 and 2009. Initial treatments were surgery (34%), radiation (32%), hormonal (22%) or watchful waiting (WW) (12%). US Census data was used to construct area-based socioeconomic measures of education and SES at the census-tract level. Univariate and multivariate polytomous logistic regression models were fitted to initial treatment with SES and EL as main predictors. The models were further adjusted for age at diagnosis, race/ethnicity, marital, smoking and insurance status, urban/rural residence and tumor grade. Results: Compared to those with a greater than a high school education, men with less than a high school education were less likely to choose surgery (OR:0.76;95%CI:0.71–0.81) or radiation (OR:0.77;95%CI:0.72–0.82) over WW. This observation was also true when comparing men with highest (OR:0.69;95%CI:0.64–0.75) and lowest (OR:0.72;95%CI:0.66–0.76) SES. In the adjusted models these associations remained for SES. Conclusions: After controlling for sociodemographic and clinical factors, there was a significant association between SES and initial treatment selection for LPC. With no gold standard for LPC treatment, it is important to understand the factors associated with a patient's initial treatment selection and their impact on health outcomes.