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, socioeconomically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socioeconomic 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. Socioeconomic 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 socioeconomic 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 socioeconomically 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.

Colorectal Cancer Screening in Castilla La Mancha, Spain: The Influence of Social, Economic, Demographic and Geographic Factors

“…Differences were detected, however, between patients living in locations with a health center and those living > 20 km from the nearest health center. Longer delay was not found to be related to distance from the hospital, which coincides with the findings of a study conducted in the United States [ 28 ], but is inconsistent with the results reported in other research [ 29 ]. Although provider delay showed no differences related to the distance from the hospital, differences were found as regards colonoscopy findings, where a higher percentage of lesions was found in patients that lived > 50 km from the hospital, while the percentage of advanced stage tumors was also slightly higher in this group.…”

Changes in five‐year survival for people with acute leukaemia in South Australia, 1980–2016

“…However, similar disparities were not found in one UK study 22 . In Australia, socio‐economic status and region are reported to influence survival of people with any cancer and of those with various non‐haematological cancers, nationally, 23,24 and in Victoria 25,26 and New South Wales 10 . The Victorian study, which combined all leukaemia types, found that mortality was higher among patients from the most socially disadvantaged than for those from the least disadvantaged areas, 25 but found no difference in mortality for metropolitan and non‐metropolitan residents 26 .…”

Disparities in quality of life, social distress and employment outcomes in Australian cancer survivors

“…A number of sociodemographic factors have been associated with variation in outcomes for cancer survivors. Cancer survival is known to vary by socio-economic advantage/disadvantage [6][7][8][9][10][11] with this difference partly explained by variations in stage at diagnosis and treatment differences [6]. Recent evidence suggests that psychosocial factors including living alone, being unmarried and higher levels of depression can also negatively impact survival [12,13].…”