The association between socioeconomic status, health insurance coverage, and quality of life in men with prostate cancer

The objective of this study was to examine the effect of socioeconomic stat us and insurance status on health-related quality of life (HRQOL) outcomes in men with prostate cancer. The design was a retrospective cohort study us ing multiple sites, including both academic and private practice settings. A cohort of 860 men with newly diagnosed, biopsy-proven prostate cancer of any stage was identified within CaPSURE, a longitudinal disease registry of prostate cancer patients. HRQOL was assessed with validated instruments, i ncluding the RAND 36-item Health Survey (SF-36) and the UCLA Prostate Cance r Index. Covariates included insurance status, education level, annual inco me, age, stage, comorbidity, Gleason grade, baseline PSA, marital status, e thnicity and primary treatment. HRQOL measurements were taken at 3-6-month intervals. Analysis of covariance was used to determine the effect of SES a nd insurance status on the HRQOL domains at baseline and over time. Patient s with lower annual income had significantly lower baseline HRQOL scores in the all of the domains of the SF-36 and four of eight disease-specific HRQ OL domains. No relationship was seen between annual income and HRQOL outcom es over time. Conversely, health insurance status was associated with HRQOL over time, but not at baseline. Health insurance status appears to have a unique effect on general HRQOL outcomes in men after treatment for prostate cancer. This study confirms the commonly held belief that patients of lowe r SES tend to have worse quality of life at baseline and following treatmen t for their disease. These findings have important ramifications for clinic ians, researchers and policy makers. (C) 2001 Elsevier Science Inc. All rig hts reserved.