Small-area data on socioeconomic status and immigrant groups for evaluating equity of early cancer detection and care

Strömberg, Ulf; Parkes, Brandon; Baigi, Amir; Bonander, Carl; Holmén, Anders; Peterson, Stefan; Piel, Frédéric B.

doi:10.1080/0284186x.2021.1878550

Cited by 6 publications

(7 citation statements)

References 27 publications

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“…Country of birth was classified as “Nordic” if born in Sweden, Norway, Denmark, Finland or Iceland; and as “non‐Nordic” otherwise. Patients' household income was used as the individual‐level SES measure 28 . Data on household income were available for each study subject (this would not be the case for the alternative individual‐level SES measures educational level and occupational social class , because such data are frequently missing for immigrants).…”

Section: Methodsmentioning

confidence: 99%

Targeting population groups with heavier burden of hepatocellular carcinoma incidence: A nationwide descriptive epidemiological study in Sweden

Vaz

Midlöv

Eilard

et al. 2022

Intl Journal of Cancer

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Contemporary European studies examining associations between socioeconomic status and hepatocellular carcinoma (HCC) incidence are scarce. We aimed to target population groups with a heavier burden of HCC by assessing associations of individual‐level sociodemographic variables and neighbourhood deprivation with all‐stage and stage‐specific HCC incidence rates (IR). Patient and population data stratified by calendar year (2012‐2018), sex, age (5‐year groups), household income (low, medium and high), country of birth (Nordic, non‐Nordic) and neighbourhood deprivation (national quintiles Q1‐Q5) were retrieved from Swedish registers. HCC stages were defined by Barcelona Clinic Liver Cancer stages 0 to A (early‐stage) and B to D (late‐stage). IR (per 100 000 person‐years) were estimated by Poisson regression models. Men had four times higher IR than women. IRs increased markedly with lower household income as well as with neighbourhood deprivation. Seven times higher IR was observed among people with a low household income living in the most deprived neighbourhoods (IR 3.90, 95% confidence interval [CI] 3.28‐4.64) compared to people with a high household income living in the least deprived neighbourhoods (IR 0.58, 95% CI 0.46‐0.74). The gradient across income categories was more pronounced for late‐stage than early‐stage HCC. IR reached 30 (per 100 000 person‐years) for people in the age span 60 to 79 years with low income and 20 for 60 to 79 year old people living in the most deprived neighbourhoods (regardless of income). Men with low household income and/or living in the most deprived neighbourhoods might be considered as primary targets in studies evaluating the cost‐effectiveness of screening for early‐stage HCC detection.

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Section: Methodsmentioning

confidence: 99%

Targeting population groups with heavier burden of hepatocellular carcinoma incidence: A nationwide descriptive epidemiological study in Sweden

Vaz

Midlöv

Eilard

et al. 2022

Intl Journal of Cancer

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“…Our analysis can be valuable for revealing socioeconomic differences in early detection of cancer. 21,22 For prostate cancer, population-based studies have addressed influence of socioeconomic characteristics (education) on early detection by individual rather than neighbourhood level analysis. [23][24][25] We were unable to find other populationbased studies investigating the influence of income or education on the use of pre-biopsy MRI, but racial and geographical disparities have been reported from the United States.…”

Section: Neigbourhood Level Educationmentioning

confidence: 99%

Socioeconomic inequality in prostate cancer diagnostics, primary treatment, rehabilitation, and mortality in Sweden

Strömberg,

Berglund,

Carlsson

et al. 2024

Intl Journal of Cancer

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We designed a nationwide study to investigate the association between socioeconomic factors (household income and education) and different aspects of prostate cancer care, considering both individual‐ and neighbourhood‐level variables. Data were obtained from Prostate Cancer data Base Sweden (PCBaSe), a research database with data from several national health care registers including clinical characteristics and treatments for nearly all men diagnosed with prostate cancer in Sweden. Four outcomes were analysed: use of pre‐biopsy magnetic resonance imaging (MRI) in 2018–2020 (n = 11,843), primary treatment of high‐risk non‐metastatic disease in 2016–2020 (n = 6633), rehabilitation (≥2 dispensed prescriptions for erectile dysfunction within 1 year from surgery in 2016–2020, n = 6505), and prostate cancer death in 7770 men with high‐risk non‐metastatic disease diagnosed in 2010–2016. Unadjusted and adjusted odds and hazard ratios (OR/HRs) with 95% confidence intervals (CIs) were calculated. Adjusted odds ratio (ORs) comparing low versus high individual education were 0.74 (95% CI 0.66–0.83) for pre‐biopsy MRI, 0.66 (0.54–0.81) for primary treatment, and 0.82 (0.69–0.97) for rehabilitation. HR gradients for prostate cancer death were significant on unadjusted analysis only (low vs. high individual education HR 1.41, 95% CI 1.17–1.70); co‐variate adjustments markedly attenuated the gradients (low vs. high individual education HR 1.10, 95% CI 0.90–1.35). Generally, neighbourhood‐level analyses showed weaker gradients over the socioeconomic strata, except for pre‐biopsy MRI. Socioeconomic factors influenced how men were diagnosed with prostate cancer in Sweden but had less influence on subsequent specialist care. Neighbourhood‐level socioeconomic data are more useful for evaluating inequality in diagnostics than in later specialist care.

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“…an analytic approach to revealing geographical differences in the burden of cancer on a small area scale [10]. Preferably, the small areas (neighbourhoods) should be defined with regard to socioeconomic conditions, segregation and population size [11,12]. I reiterate that it is important that incidences per tumour stage at diagnosis are mapped separately because stage dependent incidences contribute differently to the burden of cancer.…”

Section: Precision Prevention By Means Of Geographically Targeted and Contextualised Interventionsmentioning

confidence: 99%

“…The uptake of colorectal cancer associates with sociodemographic variables; socioeconomic and ethnic inequities in screening participation have been reported from studies in several countries [17][18][19]. Common indicators of neighbourhood deprivation, reflecting income level, educational level, unemployment and types of housing, as well as the distribution of immigrant groups, should therefore be considered [12,20]. There are several other neighbourhood-level/contextual variables of potential interest: population density, housing overcrowding, population turnover (people moving in and out in each year), daily movement statistics, access to recreation areas, access to health care, average travel time to screening clinic, etc.…”

Section: Precision Prevention By Means Of Geographically Targeted and Contextualised Interventionsmentioning

confidence: 99%

Small-area data on socioeconomic status and immigrant groups for evaluating equity of early cancer detection and care

Cited by 6 publications

References 27 publications

Targeting population groups with heavier burden of hepatocellular carcinoma incidence: A nationwide descriptive epidemiological study in Sweden

Targeting population groups with heavier burden of hepatocellular carcinoma incidence: A nationwide descriptive epidemiological study in Sweden

Socioeconomic inequality in prostate cancer diagnostics, primary treatment, rehabilitation, and mortality in Sweden

How can precision prevention be approached from a general population perspective within the field of cancer epidemiology?

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