The socioeconomic determinants of cancer.
The socioeconomic determinants of cancer.
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DOI：
10.1186/1476-069x-10-s1-s7
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发表时间：
2011-04-05
期刊：
影响因子：
--
通讯作者：
Spadea T
中科院分区：
文献类型：
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作者：
Merletti F;Galassi C;Spadea T
本文综述了不同国家和国家内癌症发病率、死亡率和存活率方面的社会经济不平等现象，特别是在意大利的背景下；文章还描述了癌症发病率的潜在机制，并报告了一些解决不平等问题的政策评论。从世界范围来看，发展中国家的癌症负担似乎尤其严重，在这些国家，许多预后较差的癌症(肝癌、胃癌和食道癌)比较富裕国家更为常见。就像在发病率和死亡率方面一样，在癌症存活率方面，我们观察到不同国家之间的差异很大。不同的研究表明，医疗保健可能对癌症存活率的社会梯度产生影响，即使在国家卫生系统提供平等医疗服务的国家也是如此。在发达国家，人们越来越认识到社会不平等是一个重要的公共卫生问题；因此，整个欧洲正在实施各种战略和政策。然而，最近的审查强调，目前关于卫生不平等政策和干预措施有效性的知识不足以为干预措施的选择和设计提供有力和循证的指导，需要进行更多的评价研究。我们在国家内部和国家之间可以衡量的健康方面的巨大差距是对世界的挑战；社会健康不平等是可以避免的，因此减少不平等是一个可以实现的目标，也是道德上的当务之急。
This paper provides a synthesis on socioeconomic inequalities in cancer incidence, mortality and survival across countries and within countries, with particular focus on the Italian context; the paper also describes the underlying mechanisms documented for cancer incidence, and reports some remarks on policies to tackle inequalities. From a worldwide perspective, the burden of cancer appears to be particularly increasing in developing countries, where many cancers with a poor prognosis (liver, stomach and oesophagus) are much more common than in richer countries. As in the case of incidence and mortality, also in cancer survival we observe a great variability across countries. Different studies have suggested a possible impact of health care on the social gradients in cancer survival, even in countries with a National Health System providing equitable access to care. In developed countries, there is increasing awareness of social inequalities as an important public health issue; as a consequence, there is a variety of strategies and policies being implemented throughout Europe. However, recent reviews emphasize that present knowledge on effectiveness of policies and interventions on health inequalities is not sufficient to offer a robust and evidence-based guide to the choice and design of interventions, and that more evaluation studies are needed. The large disparities in health that we can measure within and between countries represent a challenge to the world; social health inequalities are avoidable, and their reduction therefore represents an achievable goal and an ethical imperative.