# Prostate cancer survival according to socioeconomic and tumor characteristics in Manizales, Colombia

## TL;DR

This study analyzed prostate cancer survival in Manizales, Colombia, finding that socioeconomic factors significantly affect outcomes, with lower survival rates among vulnerable populations.

## Contribution

The study provides population-based evidence of survival disparities in prostate cancer linked to health insurance and socioeconomic status in a Colombian city.

## Key findings

- The overall five-year survival rate for prostate cancer in Manizales was 76.5%.
- Patients in subsidized and non-affiliated health insurance regimens had twice the risk of death compared to those in contributory regimens.
- Survival gaps were attributed to late diagnoses and barriers to timely treatment among socioeconomically disadvantaged groups.

## Abstract

To estimate prostate cancer survival according to socioeconomic and tumor characteristics in the municipality of Manizales, Colombia, during the 2008-2018 period, based on population-based data.

A population-based retrospective cohort study was conducted, including all incident cases of primary prostate cancer diagnosed in Manizales between 2008 and 2018, recorded in the Manizales Population-Based Cancer Registry. Overall survival was estimated using the Kaplan-Meier method, both for the total cohort and according to health insurance regimen, area of residence, socioeconomic position, age groups, histological type, essential Tumor-Node-Metastasis (TNM) classification, and risk according to Gleason score. The association between the variables of interest and survival was evaluated using Cox regression models.

The overall five-year survival was 76.5%. Significant differences in survival were identified according to the health insurance regimen, with the risk of death before five years being approximately twice as high in patients from the subsidized and non-affiliated regimen compared to those from the contributory, special, and exception regimen.

Prostate cancer survival in Manizales is lower than that reported in populations with higher levels of development. Significant gaps in survival persist according to the health insurance regimen, disadvantaging the most socioeconomically vulnerable population, possibly mediated by late diagnoses due to barriers in timely access to treatment.

Estimar la sobrevida del cáncer de próstata según características socioeconómicas y del tumor en el municipio de Manizales, Colombia, durante el periodo 2008-2018, a partir de datos de base poblacional.

Se realizó un estudio de cohorte retrospectiva de base poblacional que incluyó todos los casos incidentes de cáncer de próstata primario diagnosticados en Manizales entre 2008 y 2018, registrados en el Registro Poblacional de Cáncer de Manizales. La sobrevida global se estimó mediante el método de Kaplan-Meier, tanto para la cohorte total como según régimen de aseguramiento en salud, zona de residencia, posición socioeconómica, grupos etarios, tipo histológico, clasificación Tumor-Nódulo-Metástasis (TNM) esencial y riesgo según puntaje de Gleason. La asociación entre las variables de interés y la sobrevida se evaluó mediante modelos de regresión de Cox.

La sobrevida global a cinco años fue de 76,5%. Se identificaron diferencias significativas en la sobrevida según el régimen de aseguramiento en salud, observándose un riesgo de muerte antes de los cinco años aproximadamente dos veces mayor en los pacientes del régimen subsidiado y no afiliados, en comparación con los del régimen contributivo, especial y de excepción.

La sobrevida por cáncer de próstata en Manizales es inferior a la reportada en poblaciones con mayor nivel de desarrollo. Persisten brechas importantes en la sobrevida según el régimen de aseguramiento en salud, en desventaja de la población socioeconómicamente más vulnerable, posiblemente mediadas por diagnósticos tardíos debido a barreras en el acceso oportuno al tratamiento.