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Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data.

ABSTRACT: Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001-2015 were identified using the Victorian Cancer Registry and followed to the end of 2016. Five-year net survival and the excess risk of death due to a cancer diagnosis were estimated. People living in more disadvantaged areas had lower five-year survival than residents of less disadvantaged regions for 21 of 29 cancer types: head and neck, oesophagus, stomach, colorectum, anus/anal canal, liver, gallbladder/biliary tract, pancreas, lung, melanoma, connective/soft tissue, female breast, ovary, prostate, kidney, bladder, brain and central nervous system, unknown primary, non-Hodgkin lymphoma, multiple myeloma and leukemia. The observed lower survival in more deprived regions persisted over time, except head and neck cancer, for which the gap in survival has widened. Socio-economic inequalities in survival decreased with increasing age at diagnosis for cancers of connective/soft tissue, bladder and unknown primary. For colorectal cancer, the observed survival disadvantage in lower socio-economic regions was greater for men than for women, while for brain and central nervous system tumours, it was larger for women. Cancer survival is generally lower for residents of more socio-economically disadvantaged areas. Identifying the underlying reasons for these inequalities is important and may help to identify effective interventions to increase survival for underprivileged cancer patients.

SUBMITTER: Afshar N

PROVIDER: S-EPMC6992207 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data.

Afshar Nina N English Dallas R DR Blakely Tony T Thursfield Vicky V Farrugia Helen H Giles Graham G GG Milne Roger L RL

PloS one 20200130 1

Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001-2015 were identified using ...[more]

PMID: 31999795

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Project description:BackgroundPeople living in more deprived areas of high-income countries have lower cancer survival than those in less deprived areas. However, associations between individual-level socio-economic circumstances and cancer survival are relatively poorly understood. Moreover, few studies have addressed contextual effects, where associations between individual-level socio-economic status and cancer survival vary depending on area-based deprivation.MethodsUsing 9276 individual-level observations from a longitudinal study in England and Wales, we examined the association with cancer survival of area-level deprivation and individual-level occupation, education, and income, for colorectal, prostate and breast cancer patients aged 20-99 at diagnosis. With flexible parametric excess hazard models, we estimated excess mortality across individual-level and area-level socio-economic variables and investigated contextual effects.ResultsFor colorectal cancers, we found evidence of an association between education and cancer survival in men with Excess Hazard Ratio (EHR) = 0.80, 95% Confidence Interval (CI) = 0.60;1.08 comparing "degree-level qualification and higher" to "no qualification" and EHR = 0.74 [0.56;0.97] comparing "apprenticeships and vocational qualification" to "no qualification", adjusted on occupation and income; and between occupation and cancer survival for women with EHR = 0.77 [0.54;1.10] comparing "managerial/professional occupations" to "manual/technical," and EHR = 0.81 [0.63;1.06] comparing "intermediate" to "manual/technical", adjusted on education and income. For breast cancer in women, we found evidence of an association with income (EHR = 0.52 [0.29;0.95] for the highest income quintile compared to the lowest, adjusted on education and occupation), while for prostate cancer, all three individual-level socio-economic variables were associated to some extent with cancer survival. We found contextual effects of area-level deprivation on survival inequalities between occupation types for breast and prostate cancers, suggesting wider individual-level inequalities in more deprived areas compared to least deprived areas. Individual-level income inequalities for breast cancer were more evident than an area-level differential, suggesting that area-level deprivation might not be the most effective measure of inequality for this cancer. For colorectal cancer in both sexes, we found evidence suggesting area- and individual-level inequalities, but no evidence of contextual effects.ConclusionsFindings highlight that both individual and contextual effects contribute to inequalities in cancer outcomes. These insights provide potential avenues for more effective policy and practice.

Project description:ObjectivesTo estimate the variability of the cumulative incidence of SARS-CoV-2 infections among elementary school students attributable to individual schools and/or their geographic areas, and to ascertain whether socio-economic characteristics of school populations and/or geographic areas may be predictive of this variability.DesignPopulation-based observational study of SARS-CoV-2 infections among elementary school children.Setting3994 publicly funded elementary schools in 491 forward sortation areas (designated geographic unit based on first three characters of Canadian postal code), Ontario, Canada, September 2020 to April 2021.ParticipantsAll students attending publicly funded elementary schools with a positive molecular test for SARS-CoV-2 reported by the Ontario Ministry of Education.Main outcome measuresCumulative incidence of laboratory-confirmed elementary school student SARS-CoV-2 infections in Ontario, 2020-21 school year.ResultsA multilevel modelling approach was used to estimate the effects of socio-economic factors at the school and area levels on the cumulative incidence of elementary school student SARS-CoV-2 infections. At the school level (level 1), the proportion of the student body from low-income households was positively associated with cumulative incidence (β=0.083, p<0.001). At the area level (level 2), all dimensions of marginalisation were significantly related to cumulative incidence. Ethnic concentration (β=0.454, p<0.001), residential instability (β=0.356, p<0.001) and material deprivation (β=0.212, p<0.001) were positively related, while dependency (β=-0.204, p<0.001) was negatively related. Area-related marginalisation variables explained 57.6% of area variability in cumulative incidence. School-related variables explained 1.2% of school variability in cumulative incidence.ConclusionsThe socio-economic characteristics of the geographic area of schools were more important in accounting for the cumulative incidence of SARS-CoV-2 elementary school student infections than individual school characteristics. Schools in marginalised areas should be prioritised for infection prevention measures and education continuity and recovery plans.

Dataset Information

Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data.

Publications

Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data.

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