Measuring social class differences in cancer patient survival: Is it necessary to control for social class differences in general population mortality? A Finnish population-based study
Measuring social class differences in cancer patient survival: Is it necessary to control for social class differences in general population mortality? A Finnish population-based study
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DOI：
10.1136/jech.52.11.727
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发表时间：
1998-11-01
影响因子：
6.3
通讯作者：
Hakulinen, T
中科院分区：
文献类型：
--
作者：
Dickman, PW;Auvinen, A;Hakulinen, T
研究目的-通过观察、校正（病因特异性）和相对（基于全国人口的预期生存率）生存率，评估社会阶层癌症患者的生存率。这些措施都可能有偏差，最佳方法是使用社会阶层特定的死亡率来计算相对生存率，以估计预期生存率。本研究确定了生存措施的选择在多大程度上影响了对癌症患者生存率的社会阶层差异的估计。设置和参与者-所有在1977-1985年期间被诊断为10种常见恶性肿瘤中的至少一种的芬兰居民从芬兰癌症登记处确定，并随访死亡至1992年底。生存率的计算是通过部位，性别和年龄在5年，10年和15年后诊断的三个生存措施：相对生存，校正（原因特异性）生存，相对生存调整社会阶层差异的一般死亡率。回归模型拟合每组率的第一个五年的followingup.Main结果的变化程度，在相对生存率导致社会阶层下降，虽然没有消失，控制后的社会阶层差异，一般死亡率。使用校正生存率获得的结果接近使用社会阶层校正的相对生存率获得的结果。这三个措施之间的差异是最大的时候，从其他原因的死亡比例很大，例如，在癌症的高生存率，老年患者，并为较长的随访times. Conclusions，虽然三个措施的每一个提供了可比的结果，建议使用的相对生存率与预期的生存调整社会阶层时，研究癌症患者生存的社会阶层的变化。如果这不是一个可用的选项，则建议使用校正的存活率。没有社会阶层校正的相对生存率高估了社会阶层差异，应谨慎使用。
Study objectives-Estimation of cancer patient survival by social class has been performed using observed, corrected (cause specific), and relative (with expected survival based on the national population) survival rates. Each of these measures are potentially biased and the optimal method is to calculate relative survival rates using social class specific death rates to estimate expected survival. This study determined the degree to which the choice of survival measure affects the estimation of social class differences in cancer patient survival.Setting and participants-All Finnish residents diagnosed with at least one of 10 common malignant neoplasms during the period 1977-1985 were identified from the Finnish Cancer Registry and followed up for deaths to the end of 1992.Design-Survival rates were calculated by site, sex, and age at 5, 10, and 15 years subsequent to diagnosis for each of three measures of survival; relative survival, corrected (cause specific) survival, and relative survival adjusted for social class differences in general mortality. Regression models were fitted to each set of rates for the first five years of follow up.Main results-The degree of variation in relative survival resulting from social class decreased, although did not disappear, after controlling for social class differences in general mortality. The results obtained using corrected survival were close to those obtained using relative survival with a social class correction. The differences between the three measures were largest when the proportion of deaths from other causes was large, for example, in cancers with high survival, among older patients, and for longer follow up times.Conclusions-Although each of the three measures gave comparable results, it is recommended that relative survival rates are used with expected survival adjusted for social class when studying social class variation in cancer patient survival. if this is not an available option, it is recommended that corrected survival rates are used. Relative survival rates without the social class correction overestimate social class differences and should be used with caution.