The Combined Effect of Individual and Neighborhood Socioeconomic Status on Cancer Survival Rates

Abstract

BackgroundThis population-based study investigated the relationship between individual and neighborhood socioeconomic status (SES) and mortality rates for major cancers in Taiwan.MethodsA population-based follow-up study was conducted with 20,488 cancer patients diagnosed in 2002. Each patient was traced to death or for 5 years. The individual income-related insurance payment amount was used as a proxy measure of individual SES for patients. Neighborhood SES was defined by income, and neighborhoods were grouped as living in advantaged or disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding and risk factors.ResultsAfter adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score, urbanization, and area of residence), tumor extent, treatment modalities (operation and adjuvant therapy), and hospital characteristics (ownership and teaching level), colorectal cancer, and head and neck cancer patients under 65 years old with low individual SES in disadvantaged neighborhoods conferred a 1.5 to 2-fold higher risk of mortality, compared with patients with high individual SES in advantaged neighborhoods. A cross-level interaction effect was found in lung cancer and breast cancer. Lung cancer and breast cancer patients less than 65 years old with low SES in advantaged neighborhoods carried the highest risk of mortality. Prostate cancer patients aged 65 and above with low SES in disadvantaged neighborhoods incurred the highest risk of mortality. There was no association between SES and mortality for cervical cancer and pancreatic cancer.ConclusionsOur findings indicate that cancer patients with low individual SES have the highest risk of mortality even under a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.

Neighborhood Socioeconomic Status in Relation to All-cause, Cancer, and Cardiovascular Mortality in the Black Women’s Health Study

“…Low area-level SES has been associated with increased risk of cancer mortality in a few prospective studies, 39,[43][44][45] although a systematic review found no association. 42 Among Black Americans in the ARIC, cancer mortality rates were 30% higher in the lowest tertile of census block SES compared to the highest (.9-1.8).…”

Low Socioeconomic Status Is Associated With More Aggressive End-of-Life Care for Working-Age Terminal Cancer Patients

“…Most research explored determinants of aggressiveness of EOL care in older cancer deaths, and the results require validation in younger cohorts. For elderly patients, old age has an impact on treatment decision making for many diseases [12,31]. Older cancer patients tend to receive less aggressive treatment [3][4][5]31].…”

“…Other determinants, such as male sex, metastatic disease, and additional comorbidities, agree with previous studies from cancer deaths in those aged 65 years and older. A great body of literature has addressed the relationship between SES and mortality [12][13][14][15][16][17][18][19]. Low SES influences treatment of patients' diseases in many ways.…”

“…Studies from Taiwan and from some Western countries found that socioeconomic status (SES) caused inequalities in health [12][13][14][15][16][17][18][19][20][21][22][23]. The rates of death from cancer were higher in low-SES populations [12][13][14][15][16][17][18].…”

Distress, circadian rhythms, immunity, and survival in presurgical breast cancer patients.

“…In a study of colorectal and head and neck cancer patients in Taiwan, those with low individual SES living in disadvantaged neighborhoods has the highest mortality, as did those with breast and lung cancer with low individual SES living in advantaged neighborhoods (Chang et al, 2012).…”