Variation in prostate cancer treatment associated with population density of the county of residence

K. Clinton Cary, A. Y. Odisho, M. R. Cooperberg

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background:We sought to assess variation in the primary treatment of prostate cancer by examining the effect of population density of the county of residence on treatment for clinically localized prostate cancer and quantify variation in primary treatment attributable to the county and state level.Methods:A total 138 226 men with clinically localized prostate cancer in the Surveillance, Epidemiology and End Result (SEER) database in 2005 through 2008 were analyzed. The main association of interest was between prostate cancer treatment and population density using multilevel hierarchical logit models while accounting for the random effects of counties nested within SEER regions. To quantify the effect of county and SEER region on individual treatment, the percent of total variance in treatment attributable to county of residence and SEER site was estimated with residual intraclass correlation coefficients.Results:Men with localized prostate cancer in metropolitan counties had 23% higher odds of being treated with surgery or radiation compared with men in rural counties, controlling for number of urologists per county as well as clinical and sociodemographic characteristics. Three percent (95% confidence interval (CI): 1.2–6.2%) of the total variation in treatment was attributable to SEER site, while 6% (95% CI: 4.3–9.0%) of variation was attributable to county of residence, adjusting for clinical and sociodemographic characteristics.Conclusions:Variation in treatment for localized prostate cancer exists for men living in different population-dense counties of the country. These findings highlight the importance of comparative effectiveness research to improve understanding of this variation and lead to a reduction in unwarranted variation.Prostate Cancer and Prostatic Diseases advance online publication, 19 January 2016; doi:10.1038/pcan.2015.65.

Original languageEnglish (US)
JournalProstate Cancer and Prostatic Diseases
DOIs
StateAccepted/In press - Jan 19 2016

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Population Density
Prostatic Neoplasms
Epidemiology
Therapeutics
Comparative Effectiveness Research
Prostatic Diseases
Confidence Intervals
Publications
Logistic Models
Databases
Radiation
Population

ASJC Scopus subject areas

  • Oncology
  • Urology
  • Cancer Research

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Variation in prostate cancer treatment associated with population density of the county of residence. / Cary, K. Clinton; Odisho, A. Y.; Cooperberg, M. R.

In: Prostate Cancer and Prostatic Diseases, 19.01.2016.

Research output: Contribution to journalArticle

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abstract = "Background:We sought to assess variation in the primary treatment of prostate cancer by examining the effect of population density of the county of residence on treatment for clinically localized prostate cancer and quantify variation in primary treatment attributable to the county and state level.Methods:A total 138 226 men with clinically localized prostate cancer in the Surveillance, Epidemiology and End Result (SEER) database in 2005 through 2008 were analyzed. The main association of interest was between prostate cancer treatment and population density using multilevel hierarchical logit models while accounting for the random effects of counties nested within SEER regions. To quantify the effect of county and SEER region on individual treatment, the percent of total variance in treatment attributable to county of residence and SEER site was estimated with residual intraclass correlation coefficients.Results:Men with localized prostate cancer in metropolitan counties had 23{\%} higher odds of being treated with surgery or radiation compared with men in rural counties, controlling for number of urologists per county as well as clinical and sociodemographic characteristics. Three percent (95{\%} confidence interval (CI): 1.2–6.2{\%}) of the total variation in treatment was attributable to SEER site, while 6{\%} (95{\%} CI: 4.3–9.0{\%}) of variation was attributable to county of residence, adjusting for clinical and sociodemographic characteristics.Conclusions:Variation in treatment for localized prostate cancer exists for men living in different population-dense counties of the country. These findings highlight the importance of comparative effectiveness research to improve understanding of this variation and lead to a reduction in unwarranted variation.Prostate Cancer and Prostatic Diseases advance online publication, 19 January 2016; doi:10.1038/pcan.2015.65.",
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N2 - Background:We sought to assess variation in the primary treatment of prostate cancer by examining the effect of population density of the county of residence on treatment for clinically localized prostate cancer and quantify variation in primary treatment attributable to the county and state level.Methods:A total 138 226 men with clinically localized prostate cancer in the Surveillance, Epidemiology and End Result (SEER) database in 2005 through 2008 were analyzed. The main association of interest was between prostate cancer treatment and population density using multilevel hierarchical logit models while accounting for the random effects of counties nested within SEER regions. To quantify the effect of county and SEER region on individual treatment, the percent of total variance in treatment attributable to county of residence and SEER site was estimated with residual intraclass correlation coefficients.Results:Men with localized prostate cancer in metropolitan counties had 23% higher odds of being treated with surgery or radiation compared with men in rural counties, controlling for number of urologists per county as well as clinical and sociodemographic characteristics. Three percent (95% confidence interval (CI): 1.2–6.2%) of the total variation in treatment was attributable to SEER site, while 6% (95% CI: 4.3–9.0%) of variation was attributable to county of residence, adjusting for clinical and sociodemographic characteristics.Conclusions:Variation in treatment for localized prostate cancer exists for men living in different population-dense counties of the country. These findings highlight the importance of comparative effectiveness research to improve understanding of this variation and lead to a reduction in unwarranted variation.Prostate Cancer and Prostatic Diseases advance online publication, 19 January 2016; doi:10.1038/pcan.2015.65.

AB - Background:We sought to assess variation in the primary treatment of prostate cancer by examining the effect of population density of the county of residence on treatment for clinically localized prostate cancer and quantify variation in primary treatment attributable to the county and state level.Methods:A total 138 226 men with clinically localized prostate cancer in the Surveillance, Epidemiology and End Result (SEER) database in 2005 through 2008 were analyzed. The main association of interest was between prostate cancer treatment and population density using multilevel hierarchical logit models while accounting for the random effects of counties nested within SEER regions. To quantify the effect of county and SEER region on individual treatment, the percent of total variance in treatment attributable to county of residence and SEER site was estimated with residual intraclass correlation coefficients.Results:Men with localized prostate cancer in metropolitan counties had 23% higher odds of being treated with surgery or radiation compared with men in rural counties, controlling for number of urologists per county as well as clinical and sociodemographic characteristics. Three percent (95% confidence interval (CI): 1.2–6.2%) of the total variation in treatment was attributable to SEER site, while 6% (95% CI: 4.3–9.0%) of variation was attributable to county of residence, adjusting for clinical and sociodemographic characteristics.Conclusions:Variation in treatment for localized prostate cancer exists for men living in different population-dense counties of the country. These findings highlight the importance of comparative effectiveness research to improve understanding of this variation and lead to a reduction in unwarranted variation.Prostate Cancer and Prostatic Diseases advance online publication, 19 January 2016; doi:10.1038/pcan.2015.65.

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