Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan

Abstract

This study examined the impact of socioeconomic status on colorectal cancer risk, staging, and survival under the National Health Insurance (NHI) system in Taiwan. Monthly salary and education level were used as measures of socioeconomic status to observe the risk of colorectal cancer among individuals aged 40 years or above in 2006–2015 and survival outcomes of patients with colorectal cancer until the end of 2016. Data from 286,792 individuals were used in this study. Individuals with a monthly salary ≤Q1 were at a significantly lower incidence risk of colorectal cancer than those with a monthly salary >Q3 (HR = 0.80, 95% CI = 0.74–0.85), while those with elementary or lower education were at a significantly higher risk than those with junior college, university, or higher education (HR = 1.18, 95% CI = 1.06–1.31). The results show that socioeconomic status had no significant impact on colorectal cancer stage at diagnosis. Although salary was not associated with their risk of mortality, patients with colorectal cancer who had elementary or lower education incurred a significantly higher risk of mortality than those who had junior college, university, or higher education (HR = 1.39, 95% CI = 1.07–1.77). Education level is a significant determinant of the incidence risk and survival in patients with colorectal cancer, but only income significantly impacts incidence risk.

The association between educational status and colorectal neoplasia: results from a screening cohort

“…In line with these preliminary studies, the average age of patients with low education status was also higher in our study, indicating that these patients came for screening later in their life. Kuo et al showed for the Taiwanese population that CRC mortality is higher in patients with lower educational status [7]. Because our study cohort included only those patients who participated in local opportunistic CRC screening, we cannot make a definitive statement about the overall population.…”

“…Endoscopy is a safe method for removing precancerous growths and has been shown to reduce the incidence of CRC and CRC-related mortality [3][4][5]. Participation in CRC screening, cancer stage at diagnosis, and CRC-related mortality have all been linked to socioeconomic status [6,7]. The relationship between socioeconomic status and health outcomes is complex and not fully understood.…”

The Impact of Family Socioeconomic Status on Elderly Health in China: Based on the Frailty Index

“…Zhang et al concluded that elderly people with low socioeconomic status, poor income level, low education level, and manual labor-oriented jobs or no job mostly have severely underutilized health services or no health-care coverage at all, leading to the worsening of their own health status [ 9 ]. Kuo et al examined the impact of socioeconomic status on colorectal cancer risk, staging, and survival under the National Health Insurance system in Taiwan [ 10 ]. However, these studies mainly analyze the different dimensions of socioeconomic status and lack a comprehensive consideration of socioeconomic status.…”

The Global Status of Universal Health Coverage and Oncology Care

“…Patients' awareness has a crucial role in commitment to treatment and screening programs, which ultimately result in better outcomes in those with higher education regardless of their socioeconomic status (31).…”