Health-insurance status is a determinant of the stage at presentation and of cancer control in European men treated with radical prostatectomy for clinically localized prostate cancer.
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Health-insurance status is a determinant of the stage at presentation and of cancer control in European men treated with radical prostatectomy for clinically localized prostate cancer. / Gallina, Andrea; Karakiewicz, Pierre I; Chun, Felix; Briganti, Alberto; Graefen, Markus; Montorsi, Francesco; Walz, Jochen; Jeldres, Claudio; Erbersdobler, Andreas; Salonia, Andrea; Suardi, Nazareno; Dehò, Federico; Schlomm, Thorsten; Scattoni, Vincenzo; Haese, Alexander; Heinzer, Hans; Valiquette, Luc; Rigatti, Patrizio; Huland, Hartwig.
in: BJU INT, Jahrgang 99, Nr. 6, 6, 2007, S. 1404-1408.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Health-insurance status is a determinant of the stage at presentation and of cancer control in European men treated with radical prostatectomy for clinically localized prostate cancer.
AU - Gallina, Andrea
AU - Karakiewicz, Pierre I
AU - Chun, Felix
AU - Briganti, Alberto
AU - Graefen, Markus
AU - Montorsi, Francesco
AU - Walz, Jochen
AU - Jeldres, Claudio
AU - Erbersdobler, Andreas
AU - Salonia, Andrea
AU - Suardi, Nazareno
AU - Dehò, Federico
AU - Schlomm, Thorsten
AU - Scattoni, Vincenzo
AU - Haese, Alexander
AU - Heinzer, Hans
AU - Valiquette, Luc
AU - Rigatti, Patrizio
AU - Huland, Hartwig
PY - 2007
Y1 - 2007
N2 - OBJECTIVE: To determine whether health-insurance status might result in more localized stage at presentation, more favourable stage at surgery and in a lower rate of biochemical recurrence (BCR), in patients diagnosed with prostate cancer and treated with radical prostatectomy (RP), as despite uninhibited access to healthcare, private and public health insurance are available in most European countries. PATIENTS AND METHODS: In all, 4442 consecutive men had RP in two large European centres, of whom 2372 had public and 2070 had private health insurance. The groups were compared for several variables according to insurance status (private vs public). Means and proportions tests were complemented with logistic regression or Kaplan-Meier analyses. RESULTS: Serum prostate-specific antigen level (P <0.001), clinical stage (P <0.001), pathological Gleason sum (P = 0.02), positive surgical margin rate (18.4% vs 25.4%, P <0.001), extracapsular extension rate (17.7% vs 20.0%, P = 0.047) and seminal vesicle invasion rate (9.6% vs 11.6%, P = 0.04) were more favourable in privately insured patients. Conversely, the rate of lymph-node involvement was higher in those with private than public insurance (4.4% vs 3.3%, P = 0.045). In univariate analyses addressing pathological variables, private insurance was invariably protective (all P <0.05). The Kaplan-Meier analyses showed that privately insured patients had a lower rate of BCR after RP (log-rank P = 0.017). CONCLUSION: Despite uninhibited access to healthcare, insurance status represents a rate-limiting variable, which affects stage at presentation and the outcome of cancer control.
AB - OBJECTIVE: To determine whether health-insurance status might result in more localized stage at presentation, more favourable stage at surgery and in a lower rate of biochemical recurrence (BCR), in patients diagnosed with prostate cancer and treated with radical prostatectomy (RP), as despite uninhibited access to healthcare, private and public health insurance are available in most European countries. PATIENTS AND METHODS: In all, 4442 consecutive men had RP in two large European centres, of whom 2372 had public and 2070 had private health insurance. The groups were compared for several variables according to insurance status (private vs public). Means and proportions tests were complemented with logistic regression or Kaplan-Meier analyses. RESULTS: Serum prostate-specific antigen level (P <0.001), clinical stage (P <0.001), pathological Gleason sum (P = 0.02), positive surgical margin rate (18.4% vs 25.4%, P <0.001), extracapsular extension rate (17.7% vs 20.0%, P = 0.047) and seminal vesicle invasion rate (9.6% vs 11.6%, P = 0.04) were more favourable in privately insured patients. Conversely, the rate of lymph-node involvement was higher in those with private than public insurance (4.4% vs 3.3%, P = 0.045). In univariate analyses addressing pathological variables, private insurance was invariably protective (all P <0.05). The Kaplan-Meier analyses showed that privately insured patients had a lower rate of BCR after RP (log-rank P = 0.017). CONCLUSION: Despite uninhibited access to healthcare, insurance status represents a rate-limiting variable, which affects stage at presentation and the outcome of cancer control.
M3 - SCORING: Zeitschriftenaufsatz
VL - 99
SP - 1404
EP - 1408
JO - BJU INT
JF - BJU INT
SN - 1464-4096
IS - 6
M1 - 6
ER -
