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Son M, Kim HR, Choe SA, Song SY, Lim KH, Ki M, Heo YJ, Choi M, Go SH, Paek D. Social Inequities in the Survival of Liver Cancer: A Nationwide Cohort Study in Korea, 2007-2017. J Korean Med Sci 2024; 39:e130. [PMID: 38565179 PMCID: PMC10985499 DOI: 10.3346/jkms.2024.39.e130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/25/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND To analyze the effects of socioeconomic status (type of insurance and income level) and cancer stage on the survival of patients with liver cancer in Korea. METHODS A retrospective cohort study was constructed using data from the Healthcare Big Data Platform project in Korea between January 1, 2007, and December 31, 2017. A total of 143,511 patients in Korea diagnosed with liver cancer (International Classification of Diseases, 10th Revision [ICD-10] codes C22, C220, and C221) were followed for an average of 11 years. Of these, 110,443 died. The patient's insurance type and income level were used as indicators of socioeconomic status. Unadjusted and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a Cox proportional hazards regression model to analyze the relationship between the effects of sex, age, and cancer stage at first diagnosis (Surveillance, Epidemiology, and the End Results; SEER), type of insurance, and income level on the survival of patients with liver cancer. The interactive effects of the type of insurance, income level, and cancer stage on liver cancer death were also analyzed. RESULTS The lowest income group (medical aid) showed a higher risk for mortality (HR (95% CI); 1.37 (1.27-1.47) for all patients, 1.44 (1.32-1.57) for men, and 1.16 (1.01-1.34) for women) compared to the highest income group (1-6) among liver cancer (ICD-10 code C22) patients. The risk of liver cancer death was also higher in the lowest income group with a distant cancer stage (SEER = 7) diagnosis than for any other group. CONCLUSION Liver cancer patients with lower socioeconomic status and more severe cancer stages were at greater risk of death. Reducing social inequalities is needed to improve mortality rates among patients in lower social class groups who present with advanced cancer.
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Affiliation(s)
- Mia Son
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Hye-Ri Kim
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea.
| | - Seung-Ah Choe
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Seo-Young Song
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Kyu-Hyoung Lim
- Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Myung Ki
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
| | - Yeon Jeong Heo
- Department of Nursing, College of Nursing, Kangwon National University, Chuncheon, Korea
| | - Minseo Choi
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Seok-Ho Go
- Department of Preventive Medicine, College of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Domyung Paek
- Wonjin Institute for Occupational & Environmental Health, Seoul, Korea
- National Cancer Center, Goyang, Korea
- Graduate School of Public Health, Seoul National University, Seoul, Korea.
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Pizzato M, Martinsen JI, Heikkinen S, Vignat J, Lynge E, Sparén P, La Vecchia C, Pukkala E, Vaccarella S. Socioeconomic status and risk of lung cancer by histological subtype in the Nordic countries. Cancer Med 2022; 11:1850-1859. [PMID: 35166068 PMCID: PMC9041078 DOI: 10.1002/cam4.4548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While the excess in lung cancer risk among lower socioeconomic status individuals has been widely described, the magnitude of this association across lung cancer subtypes, as well as histotype-related long-term incidence trends, are inconclusively reported. AIMS We explored the variation in the incidence of the three main lung cancer histotypes (i.e. squamous cell carcinoma, small cell carcinoma and adenocarcinoma) by socioeconomic status (SES, i.e. upper and lower white collar, upper and lower blue collar, and farming/forestry/fishing) in the adult population of four Nordic countries (i.e. Sweden, Norway, Finland and Denmark). MATERIALS & METHODS We have used data from the Nordic Occupational Cancer Study (NOCCA), computing age-standardized incidence rates per 100,000 person-years truncated at ages 50-69 years, by sex, histotype, country and SES, for the period 1971-2005. We estimated relative risks and the corresponding 95% confidence intervals through Poisson regression models, including terms for SES, age, sex and country, as indicated. RESULTS A clear socioeconomic gradient, with a progressive increase in lung cancer risk as SES level decreases, was observed in all subtypes and in both sexes. Favourable lung cancer incidence trends were seen among men for squamous cell and small cell carcinomas, although for adenocarcinomas rates were increasing everywhere except for Finland. Among women, upward temporal trends were seen in all SES groups and for all subtypes, although rates increased to a greater extent for low, compared to high, SES, especially in Denmark and Norway. Farmers showed comparatively lower risks compared to other SES categories. DISCUSSION This prospective cohort study shows that substantial socioeconomic inequalities in the incidence of the most important lung cancer histotypes exist in the Nordic Countries, and that these inequalities are on the rise, especially among women. CONCLUSION Smoking habits are likely to largely explain the observed social gradient for lung cancer histotypes in both sexes.
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Affiliation(s)
- Margherita Pizzato
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | | | | | - Jerome Vignat
- International Agency for Research on CancerLyonFrance
| | - Elsebeth Lynge
- Nykøbing Falster HospitalUniversity of CopenhagenDenmark
| | - Pär Sparén
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholm
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community HealthUniversità degli Studi di MilanoMilanItaly
| | - Eero Pukkala
- Finnish Cancer RegistryInstitute for Statistical and Epidemiological Cancer ResearchHelsinkiFinland
- Faculty of Social Sciences, Tampere UniversityTampereFinland
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VERCELLI MARINA, LILLINI ROBERTO. Application of Socio-Economic and Health Deprivation Indices to study the relationships between socio-economic status and disease onset and outcome in a metropolitan area subjected to aging, demographic fall and socio-economic crisis. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E718-E727. [PMID: 34909500 PMCID: PMC8639118 DOI: 10.15167/2421-4248/jpmh2021.62.3.1890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/27/2021] [Indexed: 12/27/2022]
Abstract
Aims Genoa is a city affected by a deep economic, demographic and social involution. The association between disease onset and outcome and socioeconomic status (SES) was assessed in the mortality by cause in two periods, using indices referred to the distribution of deprivation in the population defined in a ten-years span (2001 to 2011). Material and Methods Two Socio-Economic and Health Deprivation Indices (SEHDIs), computed at census tract level (2001 and 2011 Censuses), were applied to analyse the SMRs by cause, age (0-64 and 65+ years) and gender of the five normalised groups of deprivation individuated in the two population distribution. The associations between SES and onset of disease was described in the mortality 2008-11 using the index referred to 2001 population. The second index, referred to 2011 population, described the associations between SES and disease outcomes in the mortality 2009-13. Two ANOVAs evaluated the statistical significance (p < 0.05) of differences in death distribution among groups. Results The population at medium-high deprivation increased in Genoa between 2001 and 2011. The mortality by age and gender showed different trends. Not significant trends (NS) in both periods regarded only the younger (respiratory diseases in both sexes, prostate cancer, diabetes in women). Linearly positives (L↑) trends in both periods were observed only in men (all cancers and lung cancers, overall mortality and cardiovascular diseases in younger, diabetes in older). Not linear trends (NL) in both periods interested both sexes for flu and pneumonia, women for lung cancer, old women for overall mortality and respiratory diseases, old men for colorectal cancers. Instead, L↑ trends in the final phases of disease interest all cancers in the elderly (NS trend at the disease onset), all cancers and breast cancer in young women, diabetes and colorectal cancers in young men (NL trends at the disease onset). On the contrary, L↑ trends at the disease onset and NL trends in the final phases regarded cardiovascular diseases in elderly, overall mortality, respiratory diseases and prostate cancer in old men, diabetes and colorectal cancers in old women. Finally, NL trends at the disease onset regarded colorectal cancers in young women (NS trend in the final phases) and breast cancer in the older (linearly negative trend, L↓, in the final phases). Discussion Deprivation trends confirmed the literature about populations shifting towards poverty. Aging-linked social risks were revealed, reflecting the weakening of social-health care, which worsened in elderly if alone. Serious problems in younger singles or in the single-parent families arose. Cardiovascular diseases, all cancers and colorectal cancers trends confirmed the advantage of less deprived when diseases are preventable and curable. Prostate and breast cancers trends reflected the rising incidence and increasing problems in care. The need of corrective interventions in social and health policies was emerging, aimed to support in a targeted way a population in an alarming condition of socio-economic deterioration.
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Affiliation(s)
- MARINA VERCELLI
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - ROBERTO LILLINI
- Analytical Epidemiology & Health Impact Unit, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
- Correspondence: Roberto Lillini. Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy - Tel: +390223903564 - E-mail:
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Campbell M, Hajizadeh M. Trends in socioeconomic inequalities in the incidence of ovarian cancer among women in Canada: 1992-2010. Women Health 2021; 61:381-392. [PMID: 33813998 DOI: 10.1080/03630242.2021.1909202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ovarian cancer is the seventh most common cancer among women worldwide. We assessed the effect of socioeconomic status on ovarian cancer incidence in Canada between 1992 and 2010. We linked data from the Canadian Cancer Registry (CCR), Canadian Census of Population (CCP), and National Household Survey (NHS) to measure socioeconomic inequalities in the incidence of ovarian cancer among Canadian women over the study period. The age-standardized relative and absolute concentration index (RC and AC, respectively) were calculated to quantify income- and education-related inequalities in the incidence of ovarian cancer in Canadian women during this period. Despite a slight increase in the crude incidence of ovarian cancer in Ontario, Quebec, New Brunswick, Newfoundland and Labrador & Prince Edward Island, and Canada as a whole, the incidence of ovarian cancer in Canada has mostly remained stable, between 13 and 15 new cases per 100,000 per year between 1992 and 2010. The estimated age-standardized RC and AC values for the study period did not indicate any statistically significant relationship between income or education status, and the incidence of ovarian cancer in Canada. Future work should be directed at seeking related risk factors other than socioeconomic status that may contribute to the incidence of this disease.
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Affiliation(s)
- Melanie Campbell
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
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Chakravarthy R, Stallings SC, Velez Edwards DR, Zhao SK, Conway D, Rao JS, Aldrich MC, Kobetz E, Wilkins CH. Determinants of stage at diagnosis of HPV-related cancer including area deprivation and clinical factors. J Public Health (Oxf) 2021; 44:18-27. [PMID: 33512511 PMCID: PMC8904191 DOI: 10.1093/pubmed/fdaa246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 07/24/2020] [Accepted: 12/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background Collecting social determinants of health in electronic health records is time-consuming. Meanwhile, an Area Deprivation Index (ADI) aggregates sociodemographic information from census data. The objective of this study was to ascertain whether ADI is associated with stage of human papillomavirus (HPV)-related cancer at diagnosis. Methods We tested for the association between the stage of HPV-related cancer presentation and ADI as well as the association between stage and the value of each census-based measure using ordered logistic regression, adjusting for age, race and sex. Results Among 3247 cases of HPV-related cancers presenting to an urban academic medical center, the average age at diagnosis was 57. The average stage at diagnosis was Surveillance, Epidemiology and End Results Stage 3. In the study population, 43% of patients were female and 87% were white. In this study population, there was no association between stage of HPV-related cancer presentation and either aggregate or individual census variables. Conclusions These results may reflect insufficient sample size, a lack of socio-demographic diversity in our population, or suggest that simplifying social determinants of health into a single geocoded index is not a reliable surrogate for assessing a patient’s risk for HPV-related cancer.
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Affiliation(s)
| | - Sarah C Stallings
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Digna R Velez Edwards
- Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA.,Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sifang Kathy Zhao
- Institute for Medicine and Public Health, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas Conway
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Sunil Rao
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA.,Division of Biostatistics, University of Miami School of Medicine, Miami, FL, USA
| | - Melinda C Aldrich
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Erin Kobetz
- Department of Public Health Sciences, University of Miami School of Medicine, Miami, FL, USA.,Department of Medicine, University of Miami, Coral Gables, FL, USA
| | - Consuelo H Wilkins
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN, USA.,Meharry-Vanderbilt Alliance, Nashville, TN, USA.,Office of Health Equity, Vanderbilt University Medical Center, Nashville, TN, USA
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Abstract
OBJECTIVE We aimed to examine the association between education level and breast cancer incidence by a meta-analysis of cohort studies. METHODS Relevant studies were identified by searching PubMed, Web of Science, and Scopus databases on June 10, 2018. Reference lists from the obtained articles were also reviewed. We included cohort studies reporting relative risks with 95% CIs for the association between education level and breast cancer incidence. Either a fixed- or random-effects model was used to calculate the pooled risk estimates. RESULTS We identified 18 cohort studies with more than 10 million women. Compared with women with a lower education level, women with a higher education level had a significantly higher risk of developing breast cancer (pooled relative risk 1.22 [95% CI, 1.14-1.30]). The results did not differ by study area or reference group. The association remained in studies that adjusted for age at first birth and parity, but was attenuated and no longer significant when the analysis was restricted to studies that adjusted for alcohol use, to studies that adjusted for age at menopause, or to studies that adjusted for hormone therapy. CONCLUSIONS A higher education level may be associated with an increased risk of developing breast cancer, in which alcohol use, age at menopause, and hormone therapy may, at least partially, play a mediating role.
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Socioeconomic inequalities in cancer incidence in Europe: a comprehensive review of population-based epidemiological studies. Radiol Oncol 2020; 54:1-13. [PMID: 32074075 PMCID: PMC7087422 DOI: 10.2478/raon-2020-0008] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/05/2020] [Indexed: 02/08/2023] Open
Abstract
Background Since the end of the previous century, there has not been a comprehensive review of European studies on socioeconomic inequality in cancer incidence. In view of recent advances in data source linkage and analytical methods, we aimed to update the knowledge base on associations between location-specific cancer incidence and individual or area-level measures of socio-economic status (SES) among European adults. Materials and methods We systematically searched three databases (PubMed, Scopus and Web of Science) for articles on cancer incidence and SES. Qualitative synthesis was performed on the 91 included English language studies, published between 2000 and 2019 in Europe, which focused on adults, relied on cancer registry data and reported on relative risk (RR) estimates. Results Adults with low SES have increased risk of head and neck, oesophagogastric, liver and gallbladder, pancreatic, lung, kidney, bladder, penile and cervical cancers (highest RRs for lung, head and neck, stomach and cervix). Conversely, high SES is linked with increased risk of thyroid, breast, prostate and skin cancers. Central nervous system and haematological cancers are not associated with SES. The positive gap in testicular cancer has narrowed, while colorectal cancer shows a varying pattern in different countries. Negative associations are generally stronger for men compared to women. Conclusions In Europe, cancers in almost all common locations are associated with SES and the inequalities can be explained to a varying degree by known life-style related factors, most notably smoking. Independent effects of many individual and area SES measures which capture different aspects of SES can also be observed.
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Sciannameo V, Ricceri F, Soldati S, Scarnato C, Gerosa A, Giacomozzi G, d'Errico A. Cancer mortality and exposure to nickel and chromium compounds in a cohort of Italian electroplaters. Am J Ind Med 2019; 62:99-110. [PMID: 30615207 DOI: 10.1002/ajim.22941] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Nickel and chromium-VI compounds are carcinogens for lung cancer, although it is still debated if there is an increased risk at low levels of exposure and for other cancers. METHODS In a cohort of 2991 Italian electroplaters, a proportion of whom were exposed to low levels of nickel and/or chromium, cumulative exposure to their compounds was obtained by multiplying average concentrations of the metals in each electroplating tank by duration of employment in the company. The association of exposure to compounds with mortality was assessed by multivariable Cox models. RESULTS No cancer site was associated with chromium exposure controlling for nickel, whereas exposure to nickel significantly increased mortality from lung, rectal, and kidney cancers, even after adjusting for exposure to chromium. CONCLUSIONS Study results suggest that exposure to nickel compounds may increase the risk of lung cancer even below its occupational exposure limit and indicate possible associations with other cancer sites.
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Affiliation(s)
- Veronica Sciannameo
- Unit of Epidemiology; Regional Health Service ASL TO3; Grugliasco (Turin) Italy
| | - Fulvio Ricceri
- Unit of Epidemiology; Regional Health Service ASL TO3; Grugliasco (Turin) Italy
- Department of Clinical and Biological Sciences; University of Turin; Orbassano (Turin) Italy
| | - Simona Soldati
- Department of Epidemiology and Environmental Health; Regional Environmental Protection Agency (ARPA Piemonte); Turin Italy
| | - Corrado Scarnato
- Department of Public Health, Prevention and Security Area Work Environments; Local Health Authority; Bologna Italy
| | - Alberto Gerosa
- Department of Public Health, Prevention and Security Area Work Environments; Local Health Authority; Bologna Italy
| | - Giuseppe Giacomozzi
- Department of Public Health, Prevention and Security Area Work Environments; Local Health Authority; Bologna Italy
| | - Angelo d'Errico
- Unit of Epidemiology; Regional Health Service ASL TO3; Grugliasco (Turin) Italy
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Capodaglio G, Zorzi M, Tognazzo S, Greco A, Michieletto F, Fedato C, Montaguti A, Turrin A, Ferro A, Cinquetti S, Russo F, Corti MC, Rugge M, Fedeli U. Impact of breast cancer screening in a population with high spontaneous coverage with mammography. TUMORI JOURNAL 2018; 104:258-265. [PMID: 30079815 DOI: 10.1177/0300891618792439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The impact of organized screening programs on breast cancer (BC) mortality is unclear in an era of high spontaneous referral of women to mammography. The aim of this study was to analyze if the introduction of mammographic screening programs reduced BC mortality in the Veneto region, Italy, despite already widespread spontaneous access to mammography. METHODS In Veneto, screening was introduced in different years between 1999 and 2009 across 21 local health units (LHUs), inviting asymptomatic women aged 50-69 years to undergo mammography biennially. We compared BC mortality for the 1995-2014 period of women aged 40-49 and 50-74 years who were resident in LHUs where screening programs started in 2003 (early LHUs) with women resident in LHUs where screening was introduced later (late LHUs). Poisson regression models were applied to incidence-based mortality (IBM), including only deaths from BC arising within the screening period. RESULTS In the prescreening period and until 2010, BC mortality rates in early and late LHUs were similar in both age groups. In the last study period (2010-2014), we observed a 10% decrease in overall BC mortality in early compared to late LHU, limited to women aged 50-74 years. IBM was reduced by 8% (95% CI 1%-16%) in the overall study period and by 16% (6%-25%) in 2010-2014. CONCLUSIONS In the Veneto region, screening programs were associated with a significant impact on BC-specific mortality; such effect appeared at least 8 years after screening implementation.
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Affiliation(s)
| | - Manuel Zorzi
- 2 Veneto Tumour Registry, Azienda Zero, Padova, Italy
| | | | | | | | - Chiara Fedato
- 4 Organizational Unit Prevention and Public Health, Veneto Region, Venice, Italy
| | - Adriana Montaguti
- 4 Organizational Unit Prevention and Public Health, Veneto Region, Venice, Italy
| | - Anna Turrin
- 4 Organizational Unit Prevention and Public Health, Veneto Region, Venice, Italy
| | - Antonio Ferro
- 5 Department of Prevention, LHU 6 Euganea, Veneto Region, Padova, Italy
| | - Sandro Cinquetti
- 6 Department of Prevention, LHU 2 Marca Trevigiana, Veneto Region, Treviso, Italy
| | - Francesca Russo
- 4 Organizational Unit Prevention and Public Health, Veneto Region, Venice, Italy
| | | | - Massimo Rugge
- 2 Veneto Tumour Registry, Azienda Zero, Padova, Italy.,7 Department of Medicine, DIMED Pathology and Cytopathology Unit, University of Padova, Padova, Italy
| | - Ugo Fedeli
- 1 Regional Epidemiology Service, Azienda Zero, Padova, Italy
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Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy). Eur J Cancer Prev 2018; 25:538-46. [PMID: 26999379 DOI: 10.1097/cej.0000000000000211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several studies suggest that population-based breast cancer screening programmes might help reduce social inequalities in breast cancer survival both by increasing early diagnosis and by improving access to effective treatments. To start disentangling the two effects, we evaluated social inequalities in quality of treatment of screen-detected breast cancer in the city of Turin (Italy). Combining data from the Audit System on Quality of Breast Cancer Treatment and the Turin Longitudinal Study, we analysed 2700 cases in the screening target age class 50-69 diagnosed in the period 1995-2008. We selected 10 indicators of the pathway of care, relative to timeliness and appropriateness of diagnosis and treatment, and three indicators of socioeconomic position: education, occupational status and housing characteristics. For each indicator of care, relative risks of failure were estimated by robust Poisson regression models, controlling for calendar period of diagnosis, size of tumour and activity volume of the surgery units. The principal predictor of failure of the good care indicators was the calendar period of diagnosis, with a general improvement with time in the quality of diagnosis and treatment, followed by size of the tumour and volume of activity. Socioeconomic indicators show only a marginal independent effect on timeliness indicators. The observed associations of quality indicators with socioeconomic characteristics are lower than expected, suggesting a possible role of the screening programme in reducing disparities in the access to good-quality treatments thanks to its capability to enter screen-detected women into a protected pathway of care.
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Monteiro PB, Monteiro Filho MP, de Figueirêdo JT, Saintrain MVDL, Bruno ZV, Carvalho FHC. Cytology-Based Screening During Antenatal Care as a Method for Preventing Cervical Cancer. Asian Pac J Cancer Prev 2017; 18:2513-2518. [PMID: 28952289 PMCID: PMC5720659 DOI: 10.22034/apjcp.2017.18.9.2513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Cervical cancer is one of the most serious threats to women’s lives. Therefore, the present study
aimed to know the dynamics in the collection of cytologic samples during antenatal care as a method of cervical cancer
screening and to identify the factors associated with its performance. Material and Methods: Analytical cross-sectional
study carried out with pregnant and postpartum women in Fortaleza, Ceará, Northeastern Brazil. Data were collected
using a questionnaire addressing sociodemographic variables, antenatal care, pregnancy and cytology-based screening
for cervical cancer during antenatal care. Measures of central tendency were calculated and the Chi-squared test and
Fisher’s exact test were used with a significance level of 5%. Results: Participants were 229 pregnant women and 89
postpartum women. Age ranged 18 to 43 years, with a mean of 27.9 years (SD=6.1). Only 35 (11%) participants had Pap
smears during antenatal care. A total of 283 women did not have Pap smears during pregnancy; of these, 229 (80.9%)
did not have the test because of lack of clear information from the health professional, 25 (8.8%) for fear of bleeding
or abortion, and 29 (10.3%) because they had had the test before pregnancy. Undergoing cytology-based screening for
cervical cancer was associated with high-risk pregnancy (p=0.002), antenatal care provided by a physician (p=0.003),
knowledge about the possibility of having the test during pregnancy (p<0.001) and paid job (p=0.043). Conclusion:
The percentage of cytology-based screening for cervical cancer during antenatal care was low. Therefore, health
education is suggested to improve this figure. However, receiving antenatal care at MEAC, having consultations with
a physician, and knowing that it is possible to have a Pap smear during pregnancy were significant protective factors
for undergoing cytology screening during pregnancy.
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Affiliation(s)
- Paula Bruno Monteiro
- Public Health Graduate Program, University of Fortaleza (UNIFOR), Fortaleza, Brazil. E-mail:
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Gadeyne S, Menvielle G, Kulhanova I, Bopp M, Deboosere P, Eikemo T, Hoffmann R, Kovács K, Leinsalu M, Martikainen P, Regidor E, Rychtarikova J, Spadea T, Strand B, Trewin C, Wojtyniak B, Mackenbach J. The turn of the gradient? Educational differences in breast cancer mortality in 18 European populations during the 2000s. Int J Cancer 2017; 141:33-44. [DOI: 10.1002/ijc.30685] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 01/31/2017] [Accepted: 02/02/2017] [Indexed: 12/14/2022]
Affiliation(s)
- S. Gadeyne
- Interface Demography, Department of Sociology; Vrij Universiteit Brussel; Brussels Belgium
- Department of Public Health; Erasmus Medical Centre; Rotterdam the Netherlands
| | - G. Menvielle
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136); Paris F75012 France
| | - I. Kulhanova
- Department of Public Health; Erasmus Medical Centre; Rotterdam the Netherlands
| | - M. Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich; Switzerland
| | - P. Deboosere
- Interface Demography, Department of Sociology; Vrij Universiteit Brussel; Brussels Belgium
| | - T.A. Eikemo
- Department of Public Health; Erasmus Medical Centre; Rotterdam the Netherlands
- Department of Sociology and Political Science; Norwegian University of Science and Technology; Trondheim Norway
| | - R. Hoffmann
- Department of Public Health; Erasmus Medical Centre; Rotterdam the Netherlands
| | - K. Kovács
- Hungarian Demographic Research Institute; Budapest Hungary
| | - M. Leinsalu
- Stockholm Centre for Health and Social Change; Södertörn University; Huddinge Sweden
- Department of Epidemiology and Biostatistics; National Institute for Health Development; Tallinn Estonia
| | - P. Martikainen
- Department of Sociology; University of Helsinki; Helsinki Finland
| | - E. Regidor
- Department of Preventive Medicine and Public Health; Universidad Complutense de Madrid; Madrid Spain
| | - J. Rychtarikova
- Department of Demography; Charles University; Prague Czech Republic
| | - T. Spadea
- Epidemiology Unit, Local Health Authority TO3 of Piedmont Region; Italy
| | - B.H. Strand
- Domain for Mental and Physical Health; Norwegian Institute of Public Health; Oslo Norway
| | - C. Trewin
- Domain for Mental and Physical Health; Norwegian Institute of Public Health; Oslo Norway
| | - B. Wojtyniak
- Department of Monitoring and Analyses of Population Health; National Institute of Public Health-National Institute of Hygiene; Warsaw Poland
| | - J.P. Mackenbach
- Department of Public Health; Erasmus Medical Centre; Rotterdam the Netherlands
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13
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Socioeconomic position and incidence of colorectal cancer in the Swedish population. Cancer Epidemiol 2016; 40:188-95. [DOI: 10.1016/j.canep.2016.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/02/2016] [Indexed: 01/20/2023]
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Stringhini S, Spadea T, Stroscia M, Onorati R, Demaria M, Zengarini N, Costa G. Decreasing educational differences in mortality over 40 years: evidence from the Turin Longitudinal Study (Italy). J Epidemiol Community Health 2015; 69:1208-16. [PMID: 26186242 DOI: 10.1136/jech-2015-205673] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/24/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recent studies suggest that inequalities in premature mortality have continued to rise over the last decade in most European countries, but not in southern European countries. METHODS In this study, we assess long-term trends (1971-2011) in absolute and relative educational inequalities in all-cause and cause-specific mortality in the Turin Longitudinal Study (Turin, Italy), a record-linkage study including all individuals resident in Turin in the 1971, 1981, 1991 and 2001 censuses, and aged 30-99 years (more than 2 million people). We examined mortality for all causes, cardiovascular disease (CVD), all cancers and specific cancers (lung, breast), as well as smoking and alcohol-related mortality. RESULTS Overall mortality substantially decreased in all educational groups over the study period, although cancer rates only slightly declined. Absolute inequalities decreased for both genders (SII=962/694 in men/women in 1972-1976 and SII=531/259 in 2007-2011, p<0.01). Among men, absolute inequalities for CVD and alcohol-related causes declined (p<0.05), while remaining stable for other causes of death. Among women, declines in absolute inequalities were observed for CVD, smoking and alcohol-related causes and lung cancer (p<0.05). Relative inequalities in all-cause mortality remained stable for men and decreased for women (RII=1.92/2.03 in men/women in 1972-1976 and RII=2.15/1.32 in 2007-2011). Among men, relative inequalities increased for smoking-related causes, while among women they decreased for all cancers, CVD, smoking-related causes and lung cancer (p<0.05). CONCLUSIONS Absolute inequalities in mortality strongly declined over the study period in both genders. Relative educational inequalities in mortality were generally stable among men; while they tended to narrow among women. In general, this study supports the hypothesis that educational inequalities in mortality have decreased in southern European countries.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Teresa Spadea
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Morena Stroscia
- Public Health and Paediatric Sciences Department, University of Turin, Turin, Italy
| | - Roberta Onorati
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Moreno Demaria
- Department of Epidemiology and Environmental Health, Regional Environment Protection Agency, Grugliasco (TO), Italy
| | - Nicolás Zengarini
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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Jiang A, Rambhatla P, Eide M. Socioeconomic and lifestyle factors and melanoma: a systematic review. Br J Dermatol 2015; 172:885-915. [PMID: 25354495 DOI: 10.1111/bjd.13500] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 12/27/2022]
Affiliation(s)
- A.J. Jiang
- Stritch School of Medicine; Loyola University Chicago; Maywood IL U.S.A
| | - P.V. Rambhatla
- Department of Dermatology; Henry Ford Hospital; New Center One; 3031 West Grand Blvd, Suite 800 Detroit MI 48202 U.S.A
| | - M.J. Eide
- Department of Dermatology; Henry Ford Hospital; New Center One; 3031 West Grand Blvd, Suite 800 Detroit MI 48202 U.S.A
- Department of Public Health Sciences; Henry Ford Hospital; New Center One; 3031 West Grand Blvd, Suite 800 Detroit MI 48202 U.S.A
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16
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Senore C, Bonelli L, Sciallero S, Casella C, Santarelli A, Armaroli P, Zanetti R, Segnan N. Assessing generalizability of the findings of sigmoidoscopy screening trials: the case of SCORE trial. J Natl Cancer Inst 2014; 107:385. [PMID: 25492939 DOI: 10.1093/jnci/dju385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Several reports indicated that volunteers enrolled in preventive trials tend to show a different profile, with respect to sociodemographic characteristics, health-related behaviors, or medical history, compared with the source population. We conducted an incidence and mortality follow-up within a cohort of subjects who had been mailed a recruitment questionnaire in the SCORE trial of sigmoidoscopy (FS) screening for colorectal cancer (CRC) to assess the impact of self-selection in the study of volunteers willing to be screened on the outcomes estimates and on the generalizability of the results. METHODS We compared baseline demographics, CRC risk, and overall mortality at 11-year follow-up of responders declaring their interest in screening, with those of nonresponders and of responders not interested in screening using logistic regression and Cox proportional hazards multivariable models. RESULTS Both subjects who volunteered in the trial and those who refused were better educated than nonresponders. Men and people younger than age 60 years were more likely to volunteer among responders. At 11-year follow-up, interested responders showed a similar CRC risk as nonresponders, while CRC mortality was substantially reduced (hazard ratio [HR] = 0.70, 95% confidence interval [CI] = 0.54 to 0.91). All-cause mortality was reduced both among interested (HR = 0.61, 95% CI = 0.57 to 0.65) and uninterested responders (HR = 0.81, 95% CI = 0.76 to 0.86). CONCLUSION The implementation of an FS population-based screening program would result in a similar reduction in CRC incidence, as observed in the SCORE trial, and likely in a larger impact on CRC mortality.
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Affiliation(s)
- Carlo Senore
- I Centro di Prevenzione Oncologica Piemonte (NS, PA, AS, CS) and Piedmont Cancer Registry (RZ), AO Città della Salute e della Scienza, Turin, Italy; Unit of Clinical Epidemiology, and Unit of Medical Oncology, IRCCS AOU San Martino-IST, Genoa, Italy (LB, SS, CC).
| | - Luigina Bonelli
- I Centro di Prevenzione Oncologica Piemonte (NS, PA, AS, CS) and Piedmont Cancer Registry (RZ), AO Città della Salute e della Scienza, Turin, Italy; Unit of Clinical Epidemiology, and Unit of Medical Oncology, IRCCS AOU San Martino-IST, Genoa, Italy (LB, SS, CC)
| | - Stefania Sciallero
- I Centro di Prevenzione Oncologica Piemonte (NS, PA, AS, CS) and Piedmont Cancer Registry (RZ), AO Città della Salute e della Scienza, Turin, Italy; Unit of Clinical Epidemiology, and Unit of Medical Oncology, IRCCS AOU San Martino-IST, Genoa, Italy (LB, SS, CC)
| | - Claudia Casella
- I Centro di Prevenzione Oncologica Piemonte (NS, PA, AS, CS) and Piedmont Cancer Registry (RZ), AO Città della Salute e della Scienza, Turin, Italy; Unit of Clinical Epidemiology, and Unit of Medical Oncology, IRCCS AOU San Martino-IST, Genoa, Italy (LB, SS, CC)
| | - Alessandra Santarelli
- I Centro di Prevenzione Oncologica Piemonte (NS, PA, AS, CS) and Piedmont Cancer Registry (RZ), AO Città della Salute e della Scienza, Turin, Italy; Unit of Clinical Epidemiology, and Unit of Medical Oncology, IRCCS AOU San Martino-IST, Genoa, Italy (LB, SS, CC)
| | - Paola Armaroli
- I Centro di Prevenzione Oncologica Piemonte (NS, PA, AS, CS) and Piedmont Cancer Registry (RZ), AO Città della Salute e della Scienza, Turin, Italy; Unit of Clinical Epidemiology, and Unit of Medical Oncology, IRCCS AOU San Martino-IST, Genoa, Italy (LB, SS, CC)
| | - Roberto Zanetti
- I Centro di Prevenzione Oncologica Piemonte (NS, PA, AS, CS) and Piedmont Cancer Registry (RZ), AO Città della Salute e della Scienza, Turin, Italy; Unit of Clinical Epidemiology, and Unit of Medical Oncology, IRCCS AOU San Martino-IST, Genoa, Italy (LB, SS, CC)
| | - Nereo Segnan
- I Centro di Prevenzione Oncologica Piemonte (NS, PA, AS, CS) and Piedmont Cancer Registry (RZ), AO Città della Salute e della Scienza, Turin, Italy; Unit of Clinical Epidemiology, and Unit of Medical Oncology, IRCCS AOU San Martino-IST, Genoa, Italy (LB, SS, CC)
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Manser CN, Bauerfeind P. Impact of socioeconomic status on incidence, mortality, and survival of colorectal cancer patients: a systematic review. Gastrointest Endosc 2014; 80:42-60.e9. [PMID: 24950641 DOI: 10.1016/j.gie.2014.03.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/05/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Christine N Manser
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
| | - Peter Bauerfeind
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zurich University Hospital, Zurich, Switzerland
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Bryere J, Dejardin O, Bouvier V, Colonna M, Guizard AV, Troussard X, Pornet C, Galateau-Salle F, Bara S, Launay L, Guittet L, Launoy G. Socioeconomic environment and cancer incidence: a French population-based study in Normandy. BMC Cancer 2014; 14:87. [PMID: 24524213 PMCID: PMC3930294 DOI: 10.1186/1471-2407-14-87] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 02/12/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The struggle against social inequalities is a priority for many international organizations. The objective of the study was to quantify the cancer burden related to social deprivation by identifying the cancer sites linked to socioeconomic status and measuring the proportion of cases associated with social deprivation. METHODS The study population comprised 68 967 cases of cancer diagnosed between 1997 and 2009 in Normandy and collected by the local registries. The social environment was assessed at an aggregated level using the European Deprivation Index (EDI). The association between incidence and socioeconomic status was assessed by a Bayesian Poisson model and the excess of cases was calculated with the Population Attributable Fraction (PAF). RESULTS For lung, lips-mouth-pharynx and unknown primary sites, a higher incidence in deprived was observed for both sexes. The same trend was observed in males for bladder, liver, esophagus, larynx, central nervous system and gall-bladder and in females for cervix uteri. The largest part of the incidence associated with deprivation was found for cancer of gall-bladder (30.1%), lips-mouth-pharynx (26.0%), larynx (23.2%) and esophagus (19.6%) in males and for unknown primary sites (18.0%) and lips-mouth-pharynx (12.7%) in females. For prostate cancer and melanoma in males, the sites where incidence increased with affluence, the part associated with affluence was respectively 9.6% and 14.0%. CONCLUSIONS Beyond identifying cancer sites the most associated with social deprivation, this kind of study points to health care policies that could be undertaken to reduce social inequalities.
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Affiliation(s)
- Josephine Bryere
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
| | - Olivier Dejardin
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
- CHU, Avenue de la Côte de Nacre, Caen 14000, France
- Federation of cancer registries of Basse-Normandie, Caen, France
| | - Veronique Bouvier
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
- CHU, Avenue de la Côte de Nacre, Caen 14000, France
- Federation of cancer registries of Basse-Normandie, Caen, France
| | | | - Anne-Valérie Guizard
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
- CRLCC, Avenue du Général Harris, Caen 14076, France
- Federation of cancer registries of Basse-Normandie, Caen, France
| | - Xavier Troussard
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
- CHU, Avenue de la Côte de Nacre, Caen 14000, France
- Federation of cancer registries of Basse-Normandie, Caen, France
| | - Carole Pornet
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
- CHU, Avenue de la Côte de Nacre, Caen 14000, France
| | - Françoise Galateau-Salle
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
- CHU, Avenue de la Côte de Nacre, Caen 14000, France
- Federation of cancer registries of Basse-Normandie, Caen, France
| | - Simona Bara
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
- Public hospital, rue Trottebec, Cherbourg 50100, France
- Federation of cancer registries of Basse-Normandie, Caen, France
| | - Ludivine Launay
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
| | - Lydia Guittet
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
- CHU, Avenue de la Côte de Nacre, Caen 14000, France
| | - Guy Launoy
- U1086 INSERM Cancers & Preventions, Avenue du Général Harris, Caen 14076, France
- CHU, Avenue de la Côte de Nacre, Caen 14000, France
- Federation of cancer registries of Basse-Normandie, Caen, France
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Rohani-Rasaf M, Abdollahi M, Jazayeri S, Kalantari N, Asadi-Lari M. Correlation of cancer incidence with diet, smoking and socio- economic position across 22 districts of Tehran in 2008. Asian Pac J Cancer Prev 2014; 14:1669-76. [PMID: 23679254 DOI: 10.7314/apjcp.2013.14.3.1669] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Variation in cancer incidence in geographical locations is due to different lifestyles and risk factors. Diet and socio-economic position (SEP) have been identified as important for the etiology of cancer but patterns are changing and inconsistent. The aim of this study was to investigate correlations of the incidence of common cancers with food groups, total energy, smoking, and SEP. MATERIALS AND METHODS In an ecological study, disaggregated cancer data through the National Cancer Registry in Iran (2008) and dietary intake, smoking habits and SEP obtained through a population based survey within the Urban Health Equity Assessment (Urban-HEART) project were correlated across 22 districts of Tehran. RESULTS Consumption of fruit, meat and dairy products adjusted for energy were positively correlated with bladder, colorectal, prostate and breast and total cancers in men and women, while these cancers were adversely correlated with bread and fat intake. Also prostate, breast, colorectal, bladder and ovarian cancers had a positive correlation with SEP; there was no correlation between SEP and skin cancer in both genders and stomach cancer in men. CONCLUSIONS The incidence of cancer was higher in some regions of Tehran which appeared to be mainly determined by SEP rather than dietary intake. Further individual data are required to investigate reasons of cancer clustering.
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Affiliation(s)
- Marzieh Rohani-Rasaf
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Ventura L, Mantellini P, Grazzini G, Castiglione G, Buzzoni C, Rubeca T, Sacchettini C, Paci E, Zappa M. The impact of immunochemical faecal occult blood testing on colorectal cancer incidence. Dig Liver Dis 2014; 46:82-6. [PMID: 24011791 DOI: 10.1016/j.dld.2013.07.017] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Revised: 06/26/2013] [Accepted: 07/24/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The efficacy of colorectal cancer screening based on faecal immunochemical test, in terms of reduction of colorectal cancer incidence, is under debate. In the district of Florence, an organized screening programme based on faecal immunochemical test has been running since the early 1990s. The aim of this study was to compare the risk of developing colorectal cancer for subjects undergoing faecal immunochemical test with those who did not undergo the test in the same period. METHODS Two cohorts were analyzed: subjects who underwent an initial faecal immunochemical test between 1993 and 1999 ("attenders"), and unscreened residents in the same municipalities invited to perform the faecal immunochemical test in the same period ("non-attenders"). Kaplan-Meier and Cox regression analysis were performed to evaluate the risk of developing colorectal cancer. RESULTS The attenders' and non-attenders' cohorts included 6961 and 26,285 subjects, respectively. Cox analysis showed a reduction in colorectal cancer incidence of 22% in the attenders' compared to the non-attenders' cohort (hazard ratio = 0.78, 95% Confidence Interval: 0.65-0.93). CONCLUSION Our results support the hypothesis that screening based on a single faecal immunochemical test every 2 years produces a significant decrease in colorectal cancer incidence after an average follow-up observation period of 11 years.
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Affiliation(s)
| | | | | | | | | | - Tiziana Rubeca
- Cancer Prevention and Research Institute, Florence, Italy
| | | | - Eugenio Paci
- Cancer Prevention and Research Institute, Florence, Italy
| | - Marco Zappa
- Cancer Prevention and Research Institute, Florence, Italy.
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Kiadaliri AA. Social disparity in breast and ovarian cancer incidence in iran, 2003-2009: a time trend province-level study. J Breast Cancer 2013; 16:372-7. [PMID: 24454458 PMCID: PMC3893338 DOI: 10.4048/jbc.2013.16.4.372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/07/2013] [Indexed: 11/30/2022] Open
Abstract
Purpose This pioneering study aimed to investigate social disparities in breast cancer (BC) and ovarian cancer (OC) incidence rates among women across Iran's provinces from 2003 to 2009. Methods Provincial level population distribution data pertaining to women were obtained from the Statistical Centre of Iran. Age-standardized incidence rates of BC and OC were gathered from the National Cancer Registry. Human Development Index was used as the provinces' social rank (SR), and rate ratio and Kunst and Mackenbach relative index of inequality were used to assess social disparities. Annual percentage change (APC) was calculated using joinpoint regression, and Spearman rank correlation was used to examine the association between APC and SR. Results It was found that over the study period, annual incidence rates rose by 11.6% and 9.7% for BC and OC, respectively. Social disparities were substantial and stable in favor of provinces with lower SR in Iran, and were more profound for BC than OC. Correlations between APC and SR were small and nonsignificant for both BC and OC. Conclusion The results showed that both BC and OC incidence increased in Iran during 2003 to 2009. There were positive associations between BC and OC incidence rates and the provinces' SR. This study's recommendations provide valuable information for health resource allocation pertaining to BC and OC control programs across provinces in Iran.
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Affiliation(s)
- Aliasghar A Kiadaliri
- Division of Health Economics, Department of Clinical Sciences-Malmö, Lund University, Malmö, Sweden. ; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Ljung R, Drefahl S, Andersson G, Lagergren J. Socio-demographic and geographical factors in esophageal and gastric cancer mortality in Sweden. PLoS One 2013; 8:e62067. [PMID: 23637965 PMCID: PMC3630145 DOI: 10.1371/journal.pone.0062067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 03/17/2013] [Indexed: 01/29/2023] Open
Abstract
Background Socio-demographic factors and area of residence might influence the development of esophageal and gastric cancer. Large-scale population-based research can determine the role of such factors. Methods This population-based cohort study included all Swedish residents aged 30–84 years in 1990–2007. Educational level, marital status, place of birth, and place of residence were evaluated with regard to mortality from esophageal or gastric cancer. Cox regression yielded hazard ratios (HR) with 95% confidence intervals (CI), adjusted for potential confounding. Results Among 84 920 565 person-years, 5125 and 12 230 deaths occurred from esophageal cancer and gastric cancer, respectively. Higher educational level decreased the HR of esophageal cancer (HR = 0.61, 95%CI 0.42–0.90 in women, HR = 0.71, 95%CI 0.60–0.84 in men) and gastric cancer (HR = 0.80, 95%CI 0.63–1.03 in women, HR = 0.73, 95%CI 0.64–0.83 in men). Being unmarried increased HR of esophageal cancer (HR = 1.64, 95%CI 1.35–1.99 in women, HR = 1.64, 95%CI 1.50–1.80 in men), but not of gastric cancer. Being born in low density populated areas increased HR of gastric cancer (HR = 1.23, 95%CI 1.10–1.38 in women, HR = 1.37, 95%CI 1.25–1.50 in men), while no strong association was found with esophageal cancer. Living in densely populated areas increased HR of esophageal cancer (HR = 1.31, 95%CI 1.14–1.50 in women, HR = 1.40, 95%CI 1.29–1.51 in men), but not of gastric cancer. Conclusion These socio-demographic inequalities in cancer mortality warrant efforts to investigate possible preventable mechanisms and to promote and support healthier lifestyles among deprived groups.
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Affiliation(s)
- Rickard Ljung
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Aguilar I, Compés L, Feja C, Rabanaque MJ, Martos C. Gastric cancer incidence and geographical variations: the influence of gender and rural and socioeconomic factors, Zaragoza (Spain). Gastric Cancer 2013; 16:245-53. [PMID: 22806416 DOI: 10.1007/s10120-012-0175-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 06/12/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Socioeconomic status (SES) and rural factors have been shown to be associated with gastric cancer epidemiology. The aim of this study was to identify geographical variations in gastric cancer incidence in Zaragoza province (Spain) during the period 1993-2002, and their association with SES and rural factors. METHODS Incident cases were extracted from the population-based Zaragoza Cancer Registry. The geographical analysis unit was the census tract (CT) in Zaragoza city (N = 462) and the municipalities for the rest of the province (N = 292). Four indexes were applied: two deprivation and two rurality indexes, included in a Bayesian risk model discretized in quartiles. Standardized incidence ratios (SIRs) were calculated using the incidence rates in Spain. SIRs were adjusted by a Bayesian generalized linear mixed model (GLMM). RESULTS From 1993 to 2002, 1,309 cases of gastric cancer were registered in Zaragoza city and 578 in the rest of the province. High risk was observed in CTs for the peripheral areas of the city. The incidence risk in men was 2 (95 % confidence interval [CI] 1.22-2.98) times higher in the most deprived CTs compared with the least deprived CTs, but no statistically significant differences were found in women. Municipalities with higher risk were observed in the north of the province, but no significant association was found with SES. Regarding the rurality index, a positive trend was observed in women, but it was statistically significant only for the most rural quartile (2.49, 95 % CI 1.07-4.92). CONCLUSIONS Geographical differences in gastric cancer incidence were detected. Although these differences could be partially explained by the deprivation index for men in Zaragoza city, deprivation index cannot explain geographical differences for women. In the rest of the province, the rurality index 1991 could explain, at least for women, geographical differences. It is still necessary to develop a deprivation index suitable for small municipalities.
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Affiliation(s)
- Isabel Aguilar
- Division of Public Health, University of Zaragoza, C/Domingo Miral S/N, 50009, Zaragoza, Spain.
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Rohani-Rasaf M, Moradi-Lakeh M, Ramezani R, Asadi-Lari M. Measuring socioeconomic disparities in cancer incidence in Tehran, 2008. Asian Pac J Cancer Prev 2013; 13:2955-60. [PMID: 22938489 DOI: 10.7314/apjcp.2012.13.6.2955] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health disparities exist among and within countries, while developing and low income countries suffer more. The aim of this study was to quantify cancer disparities with regard to socioeconomic position (SEP) in 22 districts of Tehran, Iran. METHOD According to the national cancer registry, 7599 new cancer cases were recorded within 22 districts of Tehran in 2008. Based on combined data from census and a population-based health equity study (Urban HEART), socioeconomic position (SEP) was calculated for each district. Index of disparity, absolute and relative concentration indices (ACI and RCI) were used for measuring disparities in cancer incidence. RESULTS The overall cancer age standardised rate (ASR) was 117.2 per 100,000 individuals (120.4 for men and 113.5 for women). Maximum ASR in both genders was seen in districts 6, 3, 1 and 2. Breast, colorectal, stomach, skin and prostate were the most common cancers. Districts with higher SEP had higher ASR (r=0.9, p<0.001). Positive ACI and RCI indicated that cancer cases accumulated in districts with high SEP. Female disparity was greater than for men in all measures. Breast, colorectal, prostate and bladder ASR ascended across SEP groups. Negative ACI and RCI in cervical and skin cancers in women indicate their aggregation in lower SEP groups. Breast cancer had the highest absolute disparities measure. CONCLUSION This report provides an appropriate guide and new evidence on disparities across geographical, demographic and particular SEP groups. Higher ASR in specific districts warrants further research to investigate the background predisposing factors.
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Affiliation(s)
- Marzieh Rohani-Rasaf
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Marinacci C, Grippo F, Pappagallo M, Sebastiani G, Demaria M, Vittori P, Caranci N, Costa G. Social inequalities in total and cause-specific mortality of a sample of the Italian population, from 1999 to 2007. Eur J Public Health 2013; 23:582-7. [DOI: 10.1093/eurpub/cks184] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Smailyte G, Jasilionis D, Ambrozaitiene D, Stankuniene V. Educational inequalities in cancer incidence and mortality in Lithuania: a record linkage study. Cancer Epidemiol 2012; 36:e279-83. [PMID: 22705124 DOI: 10.1016/j.canep.2012.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 05/11/2012] [Accepted: 05/17/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study is to describe associations between incidence and mortality by major cancer sites and education in Lithuania. METHODS The study is based on the linkage between all records of the 2001 population census and all records from Lithuanian Cancer Registry (cancer incidence) and Statistics Lithuania (deaths) for the period between 1 July 2001 and 31 December 2004. Education-specific incidence and mortality rate ratios were estimated by means of multivariate Poisson regression models. RESULTS We found both the positive and inverse educational gradients in cancer incidence and mortality. The risk of developing cancer (all sites) was lower among men and women with the lowest education, whereas cancer mortality was higher among lower educated men. The higher educational level was also associated with an increased risk of prostate cancer among men and an increased risk of breast cancer among women. However, prostate cancer mortality was the highest in the lowest education group, whereas breast cancer mortality among women did not show any statistically significant differences. Lower educated men had significantly higher incidence and mortality due to lung and stomach cancers. Strikingly high incidence and mortality due to cervix cancer was observed among women with secondary and lower than secondary education. CONCLUSION The results point to inequalities in early diagnosis and survival from cancer and failures ensuring equal access to medical care. Further more in-depth studies are needed in order to understand the nature and determinants of these inequalities.
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Affiliation(s)
- Giedre Smailyte
- Lithuanian Cancer Registry, Institute of Oncology, Vilnius University, Vilnius, Lithuania.
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Small but significant socioeconomic inequalities in axillary staging and treatment of breast cancer in the Netherlands. Br J Cancer 2012; 107:12-7. [PMID: 22596236 PMCID: PMC3389409 DOI: 10.1038/bjc.2012.205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The use of sentinel node biopsy (SNB), lymph node dissection, breast-conserving surgery, radiotherapy, chemotherapy and hormonal treatment for breast cancer was evaluated in relation to socioeconomic status (SES) in the Netherlands, where access to care was assumed to be equal. METHODS Female breast cancer patients diagnosed between 1994 and 2008 were selected from the nationwide population-based Netherlands Cancer Registry (N=176 505). Socioeconomic status was assessed based on income, employment and education at postal code level. Multivariable models included age, year of diagnosis and stage. RESULTS Sentinal node biopsy was less often applied in high-SES patients (multivariable analyses, ≤ 49 years: odds ratio (OR) 0.70 (95% CI: 0.56-0.89); 50-75 years: 0.85 (0.73-0.99)). Additionally, lymph node dissection was less common in low-SES patients aged ≥ 76 years (OR 1.34 (0.95-1.89)). Socioeconomic status-related differences in treatment were only significant in the age group 50-75 years. High-SES women with stage T1-2 were more likely to undergo breast-conserving surgery (+radiotherapy) (OR 1.15 (1.09-1.22) and OR 1.16 (1.09-1.22), respectively). Chemotherapy use among node-positive patients was higher in the high-SES group, but was not significant in multivariable analysis. Hormonal therapy was not related to SES. CONCLUSION Small but significant differences were observed in the use of SNB, lymph node dissection and breast-conserving surgery according to SES in Dutch breast cancer patients despite assumed equal access to health care.
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Hajian-Tilaki K, Kaveh-Ahangar T, Hajian-Tilaki E. Is educational level associated with breast cancer risk in Iranian women? Breast Cancer 2011; 19:64-70. [PMID: 21573750 DOI: 10.1007/s12282-011-0273-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND OBJECTIVE A high educational level has been found to be a risk factor of breast cancer. However, it is not clear whether such association persists after adjustment for individual risk factors of breast cancer such as parity in Iranian women. METHODS We conducted a case-control study of 100 histologically confirmed breast cancer cases and 200 age-matched controls in a genetically homogenous population, in Babol, northern Iran. Demographic, reproductive, and lifestyle data were collected by in-person interviews and clinical examination. Educational level was classified into three levels: (1) illiterate and primary level, (2) elementary level and those who did not finish high school, and (3) high school graduates and those receiving more education. The adjusted odds ratio (OR) was estimated using multiple logistic regression model after controlling for parity and several other potential confounding factors. RESULTS The unadjusted OR showed a nonsignificant negative association of educational levels with breast cancer risk, but after controlling for several potential confounding factors, higher education level was significantly correlated with a lower breast cancer risk [OR 0.17, 95% confidence interval (CI) 0.06-0.45 for educational level of elementary plus some high school and OR 0.10, 95% CI 0.03-0.34 for educational level of high school or more compared to illiterate and primary level]. CONCLUSIONS The inverse association of educational level with breast cancer risk observed in this study is not in accordance with education inequalities found in breast cancer risk in Western countries. The present findings provide a rationale for earlier screening in Iranian women with low education.
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Abstract
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.
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Affiliation(s)
- Franco Merletti
- Center for Cancer Prevention, University of Turin, San Giovanni Battista University Hospital, Italy.
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Klassen AC, Smith KC. The enduring and evolving relationship between social class and breast cancer burden: a review of the literature. Cancer Epidemiol 2011; 35:217-34. [PMID: 21470929 DOI: 10.1016/j.canep.2011.02.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 01/13/2011] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Breast cancer in women has historically been seen as a "cancer of affluence" and there is a well-documented higher incidence among women of higher social class, as well as in societies with higher resources. However, the relationship between social class and breast cancer disease characteristics, especially those associated with poorer prognosis, is less well documented, and the overall relationship between breast cancer mortality and social class has been shown to vary. Furthermore, rapid changes in women's health and health-related behaviors in societies around the world may have an impact on both incidence and mortality patterns for breast cancer in the future. METHODS A PUBMED search on breast cancer and social class (incorporating the MeSH-nested concept of SES) yielded 403 possible studies published between 1978 and 2009, of which 90 met criteria for review. Our review discusses conceptualization and measurement of women's social class in each study, as well as findings related to breast cancer incidence, tumor biology or mortality, associated with social class. FINDINGS We found mostly consistent evidence that breast cancer incidence continues to be higher in higher social class groups, with some modification of risk with adjustment for known risk factors, including physical activity and reproductive history. However, biologic characteristics associated with poorer prognosis were negatively associated with social class (i.e., greater occurrence among disadvantaged women), and mortality from breast cancer showed inconsistent relationship to social class. CONCLUSIONS We discuss these studies in relation to the growing burden of breast cancer among low resource groups and countries, and the need for cancer control strategies reflecting the emerging demographics of breast cancer risk.
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Affiliation(s)
- Ann C Klassen
- Department of Community Health and Prevention, Drexel University School of Public Health, USA.
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Reduction of socioeconomic inequality in cancer incidence in the South of the Netherlands during 1996–2008. Eur J Cancer 2010; 46:2633-46. [DOI: 10.1016/j.ejca.2010.07.039] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 07/16/2010] [Accepted: 07/22/2010] [Indexed: 12/26/2022]
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Yun EH, Lim MK, Oh JK, Park JH, Shin A, Sung J, Park EC. Combined effect of socioeconomic status, viral hepatitis, and lifestyles on hepatocelluar carcinoma risk in Korea. Br J Cancer 2010; 103:741-6. [PMID: 20648009 PMCID: PMC2938251 DOI: 10.1038/sj.bjc.6605803] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: The independent and combined effects of socioeconomic status (SES), viral hepatitis, and other lifestyle factors on hepatocellular carcinoma (HCC) risk have not been investigated among Koreans. Methods: From the National Cancer Center Hospital, 207 HCC cases and 828 age- and gender-matched controls aged 30 years or older were recruited. Socio-demographic and behavioural risk factors were ascertained through personal interview, and infection with hepatitis B and C viruses was determined by their serologic markers. Multivariate logistic regression and synergy index methods were applied for statistical analysis. Results: HB surface antigen (HbsAg) and anti-HCV-positive rates were 149.3 and 185.1 times higher in cases than controls, respectively. Lifetime alcohol consumption (odds ratio: 2.96, 95% CI: 1.29–6.79), cigarette smoking (OR: 3.53, 95% CI: 1.31–9.52), and family income (OR: 17.07, 95% CI: 4.27–68.25) were independently associated with the risk of HCC in subjects with or without viral hepatitis. Synergistic interaction on HCC risk was observed between low income and HBsAg positivity (SI: 3.12, 95% CI: 1.51–6.47) and between low income and heavy alcohol intake (SI: 2.93, 95% CI: 1.24–6.89). Conclusion: The inverse association with SES suggests SES as an independent and synergistic predictor of HCC. Heavy alcohol intake also showed a combined effect with low SES on HCC risk.
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Affiliation(s)
- E H Yun
- Branch of Cancer Risk Appraisal & Prevention, National Cancer Information Center, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyangsi, Gyeonggi-do 410-769, Republic of Korea
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Aarts MJ, Lemmens VEPP, Louwman MWJ, Kunst AE, Coebergh JWW. Socioeconomic status and changing inequalities in colorectal cancer? A review of the associations with risk, treatment and outcome. Eur J Cancer 2010; 46:2681-95. [PMID: 20570136 DOI: 10.1016/j.ejca.2010.04.026] [Citation(s) in RCA: 162] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 04/15/2010] [Accepted: 04/28/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Upcoming mass screening for colorectal cancer (CRC) makes a review of recent literature on the association with socioeconomic status (SES) relevant, because of marked and contradictory associations with risk, treatment and outcome. METHODS The Pubmed database using the MeSH terms 'Neoplasms' or 'Colorectal Neoplasms' and 'Socioeconomic Factors' for articles added between 1995 and 1st October 2009 led to 62 articles. RESULTS Low SES groups exhibited a higher incidence compared with high SES groups in the US and Canada (range risk ratio (RR) 1.0-1.5), but mostly lower in Europe (RR 0.3-0.9). Treatment, survival and mortality all showed less favourable results for people with a lower socioeconomic status: Patients with a low SES received less often (neo)adjuvant therapy (RR ranging from 0.4 to 0.99), had worse survival rates (hazard ratio (HR) 1.3-1.8) and exhibited generally the highest mortality rates up to 1.6 for colon cancer in Europe and up to 3.1 for rectal cancer. CONCLUSIONS A quite consistent trend was observed favouring individuals with a high SES compared to those with a low SES that still remains in terms of treatment, survival and thus also mortality. We did not find evidence that the low/high SES gradients for treatment chosen and outcome are decreasing. To meet increasing inequalities in mortality from CRC in Europe for people with a low SES and to make mass screening successful, a high participation rate needs to be realised of low SES people in the soon starting screening program.
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Affiliation(s)
- Mieke J Aarts
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), P.O. Box 231, 5600 AE Eindhoven, The Netherlands.
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Pagano E, Filippini C, Di Cuonzo D, Ruffini E, Zanetti R, Rosso S, Bertetto O, Merletti F, Ciccone G. Factors affecting pattern of care and survival in a population-based cohort of non-small-cell lung cancer incident cases. Cancer Epidemiol 2010; 34:483-9. [PMID: 20444663 DOI: 10.1016/j.canep.2010.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Revised: 04/02/2010] [Accepted: 04/04/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze the role of sociodemographic factors as determinants of the initial pattern of care and survival in incident NSCLC cases. METHODS We linked 2298 incident NSCLC cases, identified by the Piedmont Cancer Registry of Turin (PCRT) with administrative health records to identify the initial pattern of care. Because stage of disease strongly influences pattern of care and prognosis of NSCLC, all the analyses were stratified according to stage (early and advanced). The association between the set of patient's characteristics and the probability of accessing a specific pattern of care was analysed with a multivariable multinomial logistic regression model. Survival was analysed with the Cox proportional hazard model. RESULTS In the early stage group, presence of comorbidities, older age and low educational level were all associated with a lower probability of receiving surgery. These same factors, as well as being unmarried, were associated with higher probability of receiving other non-curative care only. The effects of comorbidities and low educational level as barriers to receiving more effective patterns of care were not relevant in the advanced stage group. When controlling for initial patterns of care, in the early stage group, an age older than 75 years and being unmarried were negative prognostic factors, while survival was completely independent from educational level. Among patients with an advanced stage of disease, only comorbidities had a negative impact on survival. CONCLUSION Appropriate lung cancer care is affected by sociodemographic factors. Greater attention to social and health programs is recommended to improve the timeliness of diagnosis, the staging of potentially resectable patients, and to implement more comprehensive multidisciplinary evaluations of those who may benefit from curative treatments.
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Spadea T, Zengarini N, Kunst A, Zanetti R, Rosso S, Costa G. Cancer risk in relationship to different indicators of adult socioeconomic position in Turin, Italy. Cancer Causes Control 2010; 21:1117-30. [PMID: 20349125 DOI: 10.1007/s10552-010-9539-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 03/10/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the magnitude of social inequalities in cancer incidence according to different socioeconomic indicators and to assess the independent role of each indicator. METHODS Data from the Turin Longitudinal Study and the Piedmont Cancer Registry (1985-1999) were used to analyse the relationship of cancer incidence with three dimensions of individual socioeconomic position (education, occupation, and material living conditions) and with an area-based deprivation index. Multivariate Poisson regression models were used to estimate both relative risks and relative indexes of inequality (RIIs). RESULTS Results showed an independent role of all the socioeconomic indicators. The overall gradients of inequalities, expressed by the RIIs for total cancer incidence, varied from 9 to 26% among men; among women, we estimated a 22% protection at the bottom of the educational hierarchy, and a 12% gradient for decreasing ease of living conditions. For most cancer sites, socioeconomic position in early adult life was as important as later socioeconomic position, while the area-based deprivation index played only an additional role. CONCLUSIONS Different socioeconomic indicators pinpoint to a series of specific risk factors that are related to specific phases of the life course. Individual level data, rather than ecological data, is preferred to accurately monitor social inequalities in cancer risk.
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Affiliation(s)
- Teresa Spadea
- Regional Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy.
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