Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study
Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study
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DOI：
10.2147/clep.s261355
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发表时间：
2020-01-01
影响因子：
3.9
通讯作者：
Sanchez, Maria-Jose
中科院分区：
文献类型：
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作者：
Angel Luque-Fernandez, Miguel;Redondo-Sanchez, Daniel;Sanchez, Maria-Jose
背景：结直肠癌（CRC）是西班牙最常见的癌症。在西班牙，没有关于癌症生存的社会经济不平等的记录。我们的目的是研究社会经济不平等与西班牙南部CRC患者总体死亡率和生存率的关系。方法：我们进行了一项基于人群的多水平队列研究，包括2011-2013年期间的CRC病例。研究时间到事件的结果是死亡，主要暴露是CRC患者的社会经济地位，通过人口普查区水平的西班牙剥夺指数评估。我们使用混合效应灵活风险模型，包括人口普查区作为随机截距，通过剥夺得出总体生存估计。结果：在3589例结直肠癌患者和12148人年风险（pyr）中，964例患者在随访结束前死亡。贫困造成的死亡率在最贫困群体中最高（96.2 / 1000 pyr, 95% CI: 84.0-110.2）。在对性别、年龄、癌症分期和居住地区进行调整后，最贫困组的超额死亡风险比较贫困组高60%（超额死亡风险比：1.6,95% CI: 1.1-2.3）。结论：我们发现剥夺与结直肠癌超额死亡率和生存率之间存在一致的关联。这些不平等背后的原因需要进一步调查，以改善所有社会群体癌症结果的平等。
Background: Colorectal cancer (CRC) is the most frequently diagnosed cancer in Spain. Socioeconomic inequalities in cancer survival are not documented in Spain. We aim to study the association of socioeconomic inequalities with overall mortality and survival among CRC patients in southern Spain.Methods: We conducted a multilevel population-based cohort study, including CRC cases for the period 2011-2013. The study time-to-event outcome was death, and the primary exposure was CRC patients' socioeconomic status assessed by the Spanish deprivation index at the census tract level. We used a mixed-effects flexible hazard model, including census tract as a random intercept, to derive overall survival estimates by deprivation.Results: Among 3589 CRC patients and 12,148 person-years at risk (pyr), 964 patients died before the end of the follow-up. Mortality by deprivation showed the highest mortality rate for the most deprived group (96.2 per 1000 pyr, 95% CI: 84.0-110.2). After adjusting for sex, age, cancer stage, and the area of residence, the most deprived had a 60% higher excess mortality risk than the less deprived group (excess mortality risk ratio: 1.6, 95% CI: 1.1-2.3).Conclusions: We found a consistent association between deprivation and CRC excess mortality and survival. The reasons behind these inequalities need further investigation in order to improve equality cancer outcomes in all social groups.