Determinants of mortality following a diagnosis of prostate cancer in veterans affairs and private sector health care systems

Objectives. We compared patterns of mortality among men with prostate cancer at 2 Department of Veterans Affairs (VA) and 2 private-sector hospitals in the Chicago area. Methods. Mortality rates for 864 cases diagnosed between 1986 and 1990 were estimated using Cox proportional hazards models that incorporated age; income; cancer stage, differentiation, and treatments; and baseline comorbidity. Results. Race tended to associate with all-cause mortality irrespective of health care setting (Blacks vs Whites: hazard rate ratio [HRR]=1.68 [95% confidence interval (Cl)=1.06, 2.67]; P<.001 in the private sector; HRR=1.50 [95% Cl=0.94, 2.38]; P=.088 in the VA). However, comorbidity determined risk in the VA, whereas age and income predicted risk in the private sector. Conclusions. Determinants of all-cause mortality in men with prostate cancer vary according to health care setting.