The importance of marital and socioeconomic status in incidence and survival of prostate cancer. An analysis of complete Norwegian birth cohorts.

Abstract

Previous studies of the association between social and family status and prostate cancer (PCa) have given somewhat divergent results. Little attention has been paid to the possible importance of these factors for survival. In this study, hazard regression models for PCa incidence and mortality were estimated on the basis of register- and census-based histories for complete Norwegian birth cohorts, giving a follow-up time of 16 million person years and 30,000 cases of PCa. A significant excess incidence of about 20% was found for ever-married men and for those with higher education. Marriage and socioeconomic resources appeared, however, to have a favorable effect on survival. Five-year relative survival from metastasized cancer among men with a high educational level was found to be 15 percentage points higher than among men with lower education. The observed differences in incidence are not easily explained. They apparently run counter to the hypothesis that multiple partners give a higher PCa risk, but may be consistent with the view that fat and meat consumption is risky. Better survival from PCa in higher socioeconomic groups and among married men may reflect differences in the search for, access to, or quality of treatment or a better constitution to fight the disease.