An investigation of cancer survival inequalities associated with individual-level socio-economic status, area-level deprivation, and contextual effects, in a cancer patient cohort in England and Wales.
An investigation of cancer survival inequalities associated with individual-level socio-economic status, area-level deprivation, and contextual effects, in a cancer patient cohort in England and Wales.
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DOI：
10.1186/s12889-022-12525-1
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发表时间：
2022-01-13
影响因子：
4.5
通讯作者：
Belot A
中科院分区：
文献类型：
--
作者：
Ingleby FC;Woods LM;Atherton IM;Baker M;Elliss-Brookes L;Belot A
生活在高收入国家较贫困地区的人的癌症存活率低于生活在较贫困地区的人。然而，个人层面的社会经济环境和癌症生存之间的关联相对知之甚少。此外，很少有研究涉及背景效应，即个人社会经济地位与癌症生存率之间的关联因地区而异。使用9276个人水平的观察，从纵向研究在英格兰和威尔士，我们研究了癌症生存的地区水平的剥夺和个人水平的职业，教育和收入，结直肠癌，前列腺癌和乳腺癌患者年龄在20-99诊断。通过灵活的参数超额风险模型，我们估计了个体水平和地区水平社会经济变量的超额死亡率，并调查了背景效应。对于结直肠癌，我们发现了男性受教育程度与癌症生存率之间存在关联的证据，超额风险比（EHR）= 0.80，95%置信区间（CI）= 0.60;1.08，将“学位水平及以上”与“无资格”进行比较，EHR = 0.74 [0.56; 0.97]比较“学徒和职业资格”与“没有资格”，根据职业和收入进行调整;以及EHR = 0.77 [0.54;将“管理/专业职业”与“手工/技术”进行比较，根据教育和收入调整后，将“中级”与“手工/技术”进行比较，EHR = 0.81 [0.63;1.06]。对于女性乳腺癌，我们发现了与收入相关的证据（EHR = 0.52 [0.29;0.95]，最高收入五分位数与最低收入五分位数相比，经教育和职业调整），而对于前列腺癌，所有三个个人水平的社会经济变量在一定程度上与癌症生存率相关。我们发现，地区层面的贫困对乳腺癌和前列腺癌职业类型之间的生存不平等产生了背景影响，这表明与最贫困地区相比，贫困程度较高的地区存在更广泛的个人层面的不平等。乳腺癌的个人收入不平等比地区一级的差异更明显，这表明地区一级的剥夺可能不是衡量这种癌症不平等的最有效措施。对于男女结直肠癌，我们发现有证据表明区域和个人水平的不平等，但没有证据表明背景效应。研究结果强调，个人和背景效应都有助于癌症结果的不平等。这些见解为更有效的政策和做法提供了潜在的途径。在线版本包含补充材料，可通过10.1186/s12889-022-12525-1获得。
People living in more deprived areas of high-income countries have lower cancer survival than those in less deprived areas. However, associations between individual-level socio-economic circumstances and cancer survival are relatively poorly understood. Moreover, few studies have addressed contextual effects, where associations between individual-level socio-economic status and cancer survival vary depending on area-based deprivation. Using 9276 individual-level observations from a longitudinal study in England and Wales, we examined the association with cancer survival of area-level deprivation and individual-level occupation, education, and income, for colorectal, prostate and breast cancer patients aged 20–99 at diagnosis. With flexible parametric excess hazard models, we estimated excess mortality across individual-level and area-level socio-economic variables and investigated contextual effects. For colorectal cancers, we found evidence of an association between education and cancer survival in men with Excess Hazard Ratio (EHR) = 0.80, 95% Confidence Interval (CI) = 0.60;1.08 comparing “degree-level qualification and higher” to “no qualification” and EHR = 0.74 [0.56;0.97] comparing “apprenticeships and vocational qualification” to “no qualification”, adjusted on occupation and income; and between occupation and cancer survival for women with EHR = 0.77 [0.54;1.10] comparing “managerial/professional occupations” to “manual/technical,” and EHR = 0.81 [0.63;1.06] comparing “intermediate” to “manual/technical”, adjusted on education and income. For breast cancer in women, we found evidence of an association with income (EHR = 0.52 [0.29;0.95] for the highest income quintile compared to the lowest, adjusted on education and occupation), while for prostate cancer, all three individual-level socio-economic variables were associated to some extent with cancer survival. We found contextual effects of area-level deprivation on survival inequalities between occupation types for breast and prostate cancers, suggesting wider individual-level inequalities in more deprived areas compared to least deprived areas. Individual-level income inequalities for breast cancer were more evident than an area-level differential, suggesting that area-level deprivation might not be the most effective measure of inequality for this cancer. For colorectal cancer in both sexes, we found evidence suggesting area- and individual-level inequalities, but no evidence of contextual effects. Findings highlight that both individual and contextual effects contribute to inequalities in cancer outcomes. These insights provide potential avenues for more effective policy and practice. The online version contains supplementary material available at 10.1186/s12889-022-12525-1.
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DOI：
10.1001/jama.2016.4226
发表时间：
2016-04-26
期刊：
JAMA
影响因子：
--
作者：
Chetty R;Stepner M;Abraham S;Lin S;Scuderi B;Turner N;Bergeron A;Cutler D
通讯作者：
Cutler D
影响因子：
2.3
作者：
Maringe C;Belot A;Rachet B
通讯作者：
Rachet B
影响因子：
2
作者：
ESTEVE, J;BENHAMOU, E;RAYMOND, L
通讯作者：
RAYMOND, L
影响因子：
6.3
作者：
Hastert, Theresa A.;Beresford, Shirley A. A.;White, Emily
通讯作者：
White, Emily
DOI：
10.1016/j.ssmph.2021.100815
发表时间：
2021-06
期刊：
SSM - population health
影响因子：
--
作者：
Ingleby FC;Woods LM;Atherton IM;Baker M;Elliss-Brookes L;Belot A
通讯作者：
Belot A