Deprivation gap in colorectal cancer survival attributable to stage at diagnosis: A population-based study in Spain
Deprivation gap in colorectal cancer survival attributable to stage at diagnosis: A population-based study in Spain
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DOI：
10.1016/j.canep.2020.101794
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发表时间：
2020-10-01
影响因子：
2.6
通讯作者：
Sanchez, Maria-Jose
中科院分区：
文献类型：
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作者：
Nunez, Olivier;Rodriguez Barranco, Miguel;Sanchez, Maria-Jose
目的：结直肠癌（CRC）生存的社会经济不平等是西班牙公共卫生系统的主要关注点。如果这些不平等主要是由于诊断阶段的差异，那么以人群为基础的筛查计划可能会大大减少它们。我们的目的是确定在何种程度上不利的阶段分布有助于生存的不平等，在西班牙地区的CRC screening programme.Methods的实施之前：我们分析了数据，从一个以人群为基础的队列研究，其中包括所有患者生活在西班牙南部的一个地区，2004年和2013年之间诊断的CRC。欧洲痴呆指数被用来分配每个病人的社会经济水平的基础上，他们的居住区。使用因果中介分析评估了肿瘤分期在社会经济群体之间生存差异中的作用。结果：共有2802名男性和1957名女性参与了该研究。对于男性来说，在确诊后的第一年，最贫困和最富裕地区之间的死亡率调整差异为每1000人年131人死亡。在这些死亡中，42例（每1000人-年）归因于诊断时的分期差异。没有社会经济差异的生存率检测女性patients.Conclusions：在这项研究中，我们主要检测社会经济差异的男性患者的短期生存。超过三分之二的不平等不能归因于诊断阶段的差异。我们的研究结果表明，除了筛查计划，其他公共卫生干预措施是必要的，以减少生存的剥夺差距。
Objective: Socioeconomic inequalities in colorectal cancer (CRC) survival are a major concern of the Spanish public health system. If these inequalities were mainly due to differences in stage at diagnosis, population-based screening programs might reduce them substantially. We aimed to determine to what extent adverse stage distribution contributed to survival inequalities in a Spanish region before the implementation of a CRC screening program.Methods: We analyzed data from a population-based cohort study that included all patients living in a region of southern Spain with CRC diagnosed between 2004 and 2013. The European Deprivation Index was used to assign each patient a socioeconomic level based on their area of residence. The role of tumor stage in survival disparities between socioeconomic groups was assessed using a causal mediation analysis.Results: A total of 2802 men and 1957 women were included in the study. For men, the adjusted difference in deaths between the most deprived and the most affluent areas was 131 deaths per 1000 person-years by the first year after diagnosis. Of these deaths, 42 (per 1000 person-years) were attributable to differences in stage at diagnosis. No socioeconomic disparities in survival were detected among female patients.Conclusions: In this study, we mainly detected socioeconomic disparities in short term survival of male patients. More than two thirds of these inequalities could not be attributed to differences in stage at diagnosis. Our results suggest that in addition to a screening program, other public health interventions are necessary to reduce the deprivation gap in survival.