National economic conditions and patient insurance status predict prostate cancer diagnosis rates and management decisions

The recent "Great Recession" from December 2007 to June 2009 presents a unique opportunity to examine whether the incidence of non-palpable prostate cancer (PCa) decreases while the use of conservative management (CM) for non-palpable PCa increases during periods of national economic hardship.

We derived national, monthly diagnosis rates and use of CM for screen-detected, non-palpable prostate cancer and patient-level insurance status from the Surveillance, Epidemiology and End Results database (2004-2011) and monthly statistics on national unemployment rates, inflation, median household income, and S&P 500 closing values from government sources. Using linear and logistic multivariable regression, we measured the correlation between national macroeconomic conditions and PCa diagnosis and treatment patterns and evaluated patient level predictors of CM use to determine if being insured by Medicaid or uninsured increased use of CM.

Diagnosis rates correlated positively with the S&P 500 monthly close (coeff 24. 90, 95% CI 6. 29 to 43. 50, p=0. 009). CM use correlated negatively with median household income (coeff=-49. 13, 95% CI -69. 29 to -28. 98, p<0. 001). Among a non-Medicare eligible population, having Medicaid (OR 1. 51, 95% CI 1. 32-1. 73, p<0. 001) or no insurance (OR 2. 27, 95% CI 1. 93-2. 67, p<0. 001) increased use of CM compared to men with private insurance. As indicated by a significant interaction term, being diagnosed during the "Great Recession" increased Medicaid insurance's predictive value of CM use (OR 1. 30, 95% CI 1. 02-1. 68, p=0. 037).

National economic hardship was associated with decreased diagnosis rates of non-palpable PCa and increased use of CM.

The Journal of urology. 2015 Dec 17 [Epub ahead of print]

Adam B Weiner, Rena M Conti, Scott E Eggener

Pritzker School of Medicine, University of Chicago, Chicago IL. , Department of Public Health Sciences and Section of Hematology/Oncology, Department of Pediatrics, University of Chicago, Chicago IL. , Section of Urology, Department of Surgery, University of Chicago, Chicago IL.