Small‐area analysis on socioeconomic inequalities in cancer survival for 25 cancer sites in Germany

Abstract

Socioeconomic inequalities in cancer survival have been reported in various countries but it is uncertain to what extent they persist in countries with relatively comprehensive health insurance coverage such as Germany. We investigated the association between area-based socioeconomic deprivation on municipality level and cancer survival for 25 cancer sites in Germany. We used data from seven population-based cancer registries (covering 32 million inhabitants). Patients diagnosed in 1998 to 2014 with one of 25 most common cancer sites were included. Area-based socioeconomic deprivation was assessed using the categorized German Index of Multiple Deprivation (GIMD) on municipality level. We estimated 3-month, 1-year, 5-year and 5-year conditional on 1-year age-standardized relative survival using period approach for 2012 to 2014. Trend analyses were conducted for periods between 2003-2005 and 2012-2014. Model-based period analysis was used to calculate relative excess risks (RER) adjusted for age and stage. In total, 2 333 547 cases were included.

Socioeconomic disparities in endometrial cancer survival in Germany: a survival analysis using population-based cancer registry data

“…The relative excess risk (RER) reported showed the most deprived patients to have an increased RER of death (adjusted for age at diagnosis RER: 1.11 95% CI (0.99–1.25)) compared to the least deprived (Jansen et al 2021 ). These finding were similar to those reported by Finke et al ( 2021 ). Finke et al reported RERs adjusted for age and stage at diagnosis for patients diagnosed during the period of 2012–2014.…”

“…In a recent study by Finke et al, the majority of cancer patients living in the most socioeconomically deprived municipalities were found to have significantly lower survival compared to the most affluent patients in Germany (Finke et al 2021 ). These findings confirm the survival disparity reported in previous studies (Brenner et al 1991 ; Jansen et al 2014 , 2020 , 2021 ).…”

Socioeconomic disparities between oral cavity cancer patients in Germany

“…Therefore, the treatment and mortality of oral cancer should be equal in different social stratums. Nevertheless, previously conducted studies report inconsistent data (22,23). While Klingelhöffer et al (23) could not find survival differences between different occupational stratums, Finke et al (22) reported clear gradients across area-based socioeconomic deprivation quintiles.…”

“…Nevertheless, previously conducted studies report inconsistent data (22,23). While Klingelhöffer et al (23) could not find survival differences between different occupational stratums, Finke et al (22) reported clear gradients across area-based socioeconomic deprivation quintiles. To investigate whether the socioeconomic status is associated with survival of oral cavity cancer in Germany, we conducted a retrospective study with 500 patients that were treated for oral cancer in our clinic, a head and neck cancer center in Saxony/East Germany, in the period from 2013 to 2019.…”

Are deprivation-specific cancer survival patterns similar according to individual-based and area-based measures? A cohort study of patients diagnosed with five malignancies in England and Wales, 2008–2016

“…It has been widely documented that there are long-standing, persistent inequalities in cancer outcomes between individuals living in more deprived areas and those living in less deprived areas in higher-income countries 1–7. These inequalities may partly explain why cancer survival in the UK is lower than other similar settings, where socioeconomic differentials tend to either be smaller or explicable by factors such as stage of disease at presentation 8–10.…”