Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data
Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data
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DOI：
10.1371/journal.pone.0228551
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发表时间：
2020-01-30
期刊：
影响因子：
3.7
通讯作者：
Milne, Roger L.
中科院分区：
文献类型：
--
作者：
Afshar, Nina;English, Dallas R.;Milne, Roger L.
尽管由于早期诊断和更好的治疗，癌症生存率总体有所提高，但社会经济弱势群体的癌症生存率低于优势群体。我们的目的是研究澳大利亚维多利亚州不同地区社会经济劣势的癌症生存率差异，并评估这些不平等是否因诊断年份、诊断年龄、诊断后时间和性别而变化。 2001-2015 年诊断出首次原发性癌症的病例通过维多利亚州癌症登记处进行识别，并追踪至 2016 年底。对五年净生存率和因癌症诊断导致的超额死亡风险进行了估计。生活在贫困地区的人们在 29 种癌症类型中的 21 种中的五年生存率低于贫困地区的居民：头颈癌、食道癌、胃癌、结直肠癌、肛门/肛管、肝癌、胆囊/胆道、胰腺、肺、黑色素瘤、结缔组织/软组织、女性乳腺癌、卵巢、前列腺、肾、膀胱、脑和中枢神经系统、未知原发性、非霍奇金淋巴瘤、多发性癌症骨髓瘤和白血病。随着时间的推移，在较贫困地区观察到的较低生存率持续存在，但头颈癌除外，头颈癌的生存率差距已经扩大。随着结缔组织/软组织癌、膀胱癌和未知原发癌诊断时年龄的增加，生存方面的社会经济不平等减少。对于结直肠癌，观察到的在社会经济地位较低的地区男性的生存劣势大于女性，而对于脑肿瘤和中枢神经系统肿瘤，女性的生存劣势更大。对于社会经济较为弱势地区的居民来说，癌症存活率通常较低。找出这些不平等的根本原因很重要，可能有助于确定有效的干预措施，以提高贫困癌症患者的生存率。
Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic 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. Socio-economic 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 socio-economic 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 socio-economically 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.