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Eley C, Hawkes ND, Barlow E, Egan RJ, Lewis W. Prognostic impact of deprivation on esophagogastroduodenoscopy outcome. Endosc Int Open 2024; 12:E818-E829. [PMID: 38966320 PMCID: PMC11221896 DOI: 10.1055/a-2297-9905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/22/2024] [Indexed: 07/06/2024] Open
Abstract
Background and study aims Socioeconomic deprivation has long been associated with many gastrointestinal diseases, yet its influence on esophagogastroduodenoscopy (EGD) diagnosis has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of EGD irrespective of referral reason. Patients and methods Two thousand consecutive patients presenting to four Health Boards in Wales beginning in June 2019 were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were subclassified into quintiles for analysis (Q1 most, Q5 least deprived). Results Inhabitants of the most deprived areas were more likely to be diagnosed with peptic ulcer (Q1 7.9%, Q5 4.7%; odds ratio [OR] 0.498, P =0.018), severe esophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, P 0.002), Helicobacter pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, P =0.002), but less likely to be diagnosed with Barrett's esophagus (Q1 6.3% v Q5 12.3%, OR 2.146, P =0.004) than those from the least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after presentation for urgent suspected cancer (USC, n=35, 4.6%) than for routine referrals (n=3, 0.6%, P < 0.001). Deprivation was associated with more advanced stage cancer (stage III Q1 16.7% v Q5 5.6%, OR 0.997, P =0.006: stage IV Q1 16.7% v Q2 38.9% v Q5 22.2%, OR 0.998, P =0.049). Conclusions Deprivation was associated with two-fold more peptic ulcer disease, three-fold more H. pylori infection, and 12-fold more severe esophagitis, and more advanced cancer stage.
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Affiliation(s)
- Catherine Eley
- School of Surgery, NHS Wales Health Education and Improvement Wales, Nantgarw, CF15 7QQ, United Kingdom of Great Britain and Northern Ireland
- General Surgery, University Hospital of Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - Neil D Hawkes
- Department of Gastroenterology, Cwm Taf University Health Board, Abercynon, United Kingdom of Great Britain and Northern Ireland
| | - Emma Barlow
- Department of Surgery, Morriston Hospital, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Richard John Egan
- Department of Surgery, Morriston Hospital, Swansea, United Kingdom of Great Britain and Northern Ireland
- School of Surgery, Swansea University, Swansea, United Kingdom of Great Britain and Northern Ireland
| | - Wyn Lewis
- General Surgery, University Hospital of Wales, Cardiff, United Kingdom of Great Britain and Northern Ireland
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Tron L, Fauvernier M, Bouvier AM, Robaszkiewicz M, Bouvier V, Cariou M, Jooste V, Dejardin O, Remontet L, Alves A, Molinié F, Launoy G. Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study. Cancers (Basel) 2021; 13:cancers13205156. [PMID: 34680305 PMCID: PMC8533795 DOI: 10.3390/cancers13205156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/16/2022] Open
Abstract
Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006-2009, collected through the French network of cancer registries, were included (end of follow-up 30 June 2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.
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Affiliation(s)
- Laure Tron
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Correspondence:
| | - Mathieu Fauvernier
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France; (M.F.); (L.R.)
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, University of Lyon 1, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Anne-Marie Bouvier
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, INSERM UMR 1231, University of Burgundy, 21079 Dijon, France; (A.-M.B.); (V.J.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
| | - Michel Robaszkiewicz
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Tumors Registry of Finistère, EA SPURBO 7479, CHRU Morvan, 29200 Brest, France
| | - Véronique Bouvier
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Cancer Registry of Calvados, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| | - Mélanie Cariou
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Digestive Tumors Registry of Finistère, EA SPURBO 7479, CHRU Morvan, 29200 Brest, France
| | - Valérie Jooste
- Digestive Cancer Registry of Burgundy, Dijon University Hospital, INSERM UMR 1231, University of Burgundy, 21079 Dijon, France; (A.-M.B.); (V.J.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
| | - Olivier Dejardin
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
| | - Laurent Remontet
- Service de Biostatistique–Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France; (M.F.); (L.R.)
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, University of Lyon 1, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Arnaud Alves
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
- Department of Digestive Surgery, University Hospital of Caen, 14000 Caen, France
| | | | - Florence Molinié
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Loire-Atlantique/Vendée Cancer Registry, 44000 Nantes, France
- CERPOP, Université de Toulouse, Inserm, UPS, 31000 Toulouse, France
| | - Guy Launoy
- ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France; (V.B.); (O.D.); (A.A.); (G.L.)
- French Network of Cancer Registries, 31000 Toulouse, France; (M.R.); (M.C.); (F.M.)
- Research Department, Caen University Hospital, ‘ANTICIPE’ U1086 INSERM-UCN, Normandie University UNICAEN, Centre François Baclesse, 14000 Caen, France
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Willis K, Hajizadeh M. Socioeconomic inequalities in gastric cancer incidence in Canada: 1992-2010. Acta Oncol 2020; 59:1333-1337. [PMID: 32401113 DOI: 10.1080/0284186x.2020.1764098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kurt Willis
- Faculty of Medicine, Dalhousie University, Halifax, Canada
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Henson KE, Fry A, Lyratzopoulos G, Peake M, Roberts KJ, McPhail S. Sociodemographic variation in the use of chemotherapy and radiotherapy in patients with stage IV lung, oesophageal, stomach and pancreatic cancer: evidence from population-based data in England during 2013-2014. Br J Cancer 2018; 118:1382-1390. [PMID: 29743552 PMCID: PMC5959922 DOI: 10.1038/s41416-018-0028-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/17/2018] [Accepted: 01/24/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Sociodemographic inequalities in cancer treatment have been generally described, but there is little evidence regarding patients with advanced cancer. Understanding variation in the management of these patients may provide insights into likely mechanisms leading to inequalities in survival. METHODS We identified 50,232 patients with stage IV lung, oesophageal, pancreatic and stomach cancer from the English national cancer registry. A generalised linear model with a Poisson error structure was used to explore variation in radiotherapy and chemotherapy within 6 months from diagnosis by age, sex, deprivation, ethnicity, cancer site, comorbidity and, additionally, performance status. RESULTS There was substantial variation by cancer site, large gradients by age, and non-trivial associations with comorbidity and deprivation. After full adjustment, more deprived patients were consistently least likely to be treated with chemotherapy alone or chemotherapy and radiotherapy combined compared with less deprived patients with equally advanced disease stage (treatment rate ratio: 0.82 95% CI (0.78, 0.87) for CT, 0.78 95% CI (0.71, 0.85) for CTRT p < 0.0001). CONCLUSIONS There was marked variation in the management of patients with stage IV cancer. Routinely collected data could be used for surveillance across all cancers to help reduce treatment variation and optimise outcomes among patients with advanced cancer.
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Affiliation(s)
- Katherine E Henson
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK.
| | - Anna Fry
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
- Cancer Research UK, Angel Building, London, EC1V 4AD, UK
| | - Georgios Lyratzopoulos
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
- ECHO (Epidemiology of Cancer Healthcare and Outcomes) Group, Department of Behavioural Science and Health, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
| | - Michael Peake
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
- University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
- Centre for Cancer Outcomes, University College London Hospitals (UCLH) Cancer Collaborative, UCLH Cancer Division, 47 Wimpole Street, London, W1G 8SE, UK
| | - Keith J Roberts
- Nuffield House, University Hospitals Birmingham, Edgbaston, Birmingham, B15 2TH, UK
| | - Sean McPhail
- National Cancer Registration and Analysis Service, Public Health England, Skipton House, London, SE1 6LH, UK
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The socioeconomic profile of a Barrett's oesophagus cohort assessed by the 2010 Index of Multiple Deprivation. Eur J Gastroenterol Hepatol 2016; 28:199-204. [PMID: 26571328 DOI: 10.1097/meg.0000000000000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Several reports have described the relationship between socioeconomic status and oesophageal adenocarcinoma but only one with its precursor condition, Barrett's oesophagus. We therefore investigated such an association. PATIENTS The majority (88%) of patients diagnosed with Barrett's at Rotherham District General Hospital between 28 April 1978 and 31 August 2012 consented to inclusion in the UK Barrett's Oesophagus Registry. Those residing within Rotherham form the basis of this study. METHODS We assessed socioeconomic status using the Index of Multiple Deprivation 2010 scores which can be assigned to every English postcode. The scores for the whole of England were divided into five equal groups; those of the 6257 postcodes within Rotherham (including those of Barrett's patients) were compared against the national quintile relevant to their score. We examined the ratio of observed against expected numbers of Barrett's in each quintile before and since 2001, the median year of diagnosis. RESULTS The study group comprised 1076 patients with Barrett's oesophagus. Before 2001 their distribution across the deprivation quintiles was similar to that expected. Since then it has changed significantly, with 37% more Barrett's patients than expected among the two least deprived quintiles, but 11% fewer than expected in the larger population comprising the two most deprived quintiles (P=0.0001). There was no significant difference in the distribution of sex (P=0.27), nor the mean age at diagnosis between the two time periods (P=0.92). CONCLUSION Since 2001, there has been a major change in the distribution of Barrett's in relation to socioeconomic status, measured by the Index of Multiple Deprivation.
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Koëter M, van Steenbergen L, Lemmens V, Rutten H, Roukema J, Nieuwenhuijzen G. Determinants in decision making for curative treatment and survival in patients with resectable oesophageal cancer in the Netherlands: a population-based study. Cancer Epidemiol 2015; 39:863-9. [DOI: 10.1016/j.canep.2015.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/26/2015] [Accepted: 10/07/2015] [Indexed: 01/30/2023]
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Bryere J, Pornet C, Dejardin O, Launay L, Guittet L, Launoy G. Correction of misclassification bias induced by the residential mobility in studies examining the link between socioeconomic environment and cancer incidence. Cancer Epidemiol 2015; 39:256-64. [DOI: 10.1016/j.canep.2014.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 12/05/2014] [Accepted: 12/17/2014] [Indexed: 11/15/2022]
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Brusselaers N, Mattsson F, Lindblad M, Lagergren J. Association between education level and prognosis after esophageal cancer surgery: a Swedish population-based cohort study. PLoS One 2015; 10:e0121928. [PMID: 25811880 PMCID: PMC4374844 DOI: 10.1371/journal.pone.0121928] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 02/14/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An association between education level and survival after esophageal cancer has recently been indicated, but remains uncertain. We conducted a large study with long follow-up to address this issue. METHODS This population-based cohort study included all patients operated for esophageal cancer in Sweden between 1987 and 2010 with follow-up until 2012. Level of education was categorized as compulsory (≤9 years), intermediate (10-12 years), or high (≥13 years). The main outcome measure was overall 5-year mortality after esophagectomy. Cox regression was used to estimate associations between education level and mortality, expressed as hazard ratios (HRs) with 95% confidence intervals (CIs), with adjustment for sex, age, co-morbidity, tumor stage, tumor histology, and assessing the impact of education level over time. RESULTS Compared to patients with high education, the adjusted HR for mortality was 1.29 (95% CI 1.07-1.57) in the intermediate educated group and 1.42 (95% CI 1.17-1.71) in the compulsory educated group. The largest differences were found in early tumor stages (T-stage 0-1), with HRs of 1.73 (95% CI 1.00-2.99) and 2.58 (95% CI 1.51-4.42) for intermediate and compulsory educated patients respectively; and for squamous cell carcinoma, with corresponding HRs of 1.38 (95% CI 1.07-1.79) and 1.52 (95% CI 1.19-1.95) respectively. CONCLUSIONS This Swedish population-based study showed an association between higher education level and improved survival after esophageal cancer surgery, independent of established prognostic factors. The associations were stronger in patients of an early tumor stage and squamous cell carcinoma.
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Affiliation(s)
- Nele Brusselaers
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lindblad
- Department of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Division of Cancer Studies, King's College London, London, United Kingdom
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Sinding C, Warren R, Fitzpatrick-Lewis D, Sussman J. Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours. Support Care Cancer 2014; 22:3101-20. [PMID: 25120008 DOI: 10.1007/s00520-014-2348-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/29/2014] [Indexed: 02/03/2023]
Abstract
The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care. We then consider conceptual challenges and opportunities in the field, including how treatment disparities are defined, how equity stratifiers are defined and conceptualized and how disparities are explained, with special attention to the challenge of psychosocial explanations.
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Affiliation(s)
- Christina Sinding
- School of Social Work & Department of Health, Aging and Society, McMaster University, Hamilton, Ontario, Canada,
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Brusselaers N, Mattsson F, Johar A, Wikman A, Lagergren P, Lagergren J, Ljung R. Marital status and survival after oesophageal cancer surgery: a population-based nationwide cohort study in Sweden. BMJ Open 2014; 4:e005418. [PMID: 24907248 PMCID: PMC4054621 DOI: 10.1136/bmjopen-2014-005418] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES A beneficial effect of being married on survival has been shown for several cancer types, but is unclear for oesophageal cancer. The objective of this study was to clarify the potential influence of the marital status on the overall and disease-specific survival after curatively intended treatment of oesophageal cancer using a nationwide population-based design, taking into account the known major prognostic variables. DESIGN Prospective, population-based cohort. SETTING All Swedish hospitals performing surgery for oesophageal cancer during 2001-2005. PARTICIPANTS This study included 90% of all patients with oesophageal or junctional cancer who underwent surgical resection in Sweden in 2001-2005, with follow-up until death or the end of the study period (2012). PRIMARY AND SECONDARY OUTCOME MEASURES Cox regression was used to estimate associations between the marital status and the 5-year overall and disease-specific mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. RESULTS Of all 606 included patients (80.4% men), 55.1% were married, 9.2% were remarried, 22.6% were previously married and 13% were never married. Compared with the married patients, the never married (HR 1.02, 95% CI 0.77 to 1.35), previously married (HR 0.90, 95% CI 0.71 to 1.15) and remarried patients (HR 0.79, 95% CI 0.55 to 1.13) had no increased overall 5-year mortality. The corresponding HRs for disease-specific survival, and after excluding the initial 90 days of surgery, were similar to the HRs for the overall survival. CONCLUSIONS This study showed no evidence of a better 5-year survival in married patients compared with non-married patients undergoing surgery for oesophageal cancer.
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Affiliation(s)
- Nele Brusselaers
- Unit of Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Unit of Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Asif Johar
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anna Wikman
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Lagergren
- Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Lagergren
- Unit of Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Division of Cancer Studies, King’s College London, London, UK
| | - Rickard Ljung
- Unit of Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Brusselaers N, Ljung R, Mattsson F, Johar A, Wikman A, Lagergren P, Lagergren J. Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study. BMJ Open 2013; 3:e003754. [PMID: 24302504 PMCID: PMC3855588 DOI: 10.1136/bmjopen-2013-003754] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer. DESIGN A prospective, population-based cohort study. SETTING Sweden-nationwide. PARTICIPANTS 90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001-2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10-12 years) or high (≥13 years). OUTCOME MEASURES The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category. RESULTS Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages. CONCLUSIONS This study provides limited evidence of an association between lower education and worse long-term survival after oesophagectomy for cancer.
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Affiliation(s)
- Nele Brusselaers
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Asif Johar
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Anna Wikman
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Pernilla Lagergren
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Lagergren
- Unit of Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Division of Cancer Studies, King's College London, London, UK
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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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Launay L, Dejardin O, Pornet C, Morlais F, Guittet L, Launoy G, Bouvier V. Influence of socioeconomic environment on survival in patients diagnosed with esophageal cancer: a population-based study. Dis Esophagus 2012; 25:723-30. [PMID: 22292704 DOI: 10.1111/j.1442-2050.2011.01312.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The influence of social environment on survival in patients with cancer has been demonstrated in many studies, subjects living in the most deprived areas having a poorer prognosis. Geographic remoteness and limited access to specialized care centers are often associated with socioeconomic deprivation. The aim was to assess the influence of social environment and geographic remoteness on the relative survival of patients diagnosed with esophageal cancer between 1997 and 2004 in the department of Calvados in France. The study population, which was provided by the Calvados digestive cancer registry, included 629 patients. Relative survival was used to estimate the influence of social environment and geographic remoteness on patient survival. Five-year survival rates were 14.1%, 15.1%, 11.8%, 8.8%, and 11.4%, respectively, for patients living in the least to the most deprived areas (P= 0.39). The influence of social environment was significant after adjustment for clinical variables, patients living in the most deprived areas having the worst survival. These discrepancies cannot totally be explained by differences in access to care, cancer extension, or morphology at diagnosis. No association was observed between distance to the nearest cancer center and survival. Social environment appears to induce disparities among patients diagnosed with esophageal cancer, with a worse prognosis for patients living in the most deprived areas.
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Affiliation(s)
- L Launay
- National Institute for Health and Medical Research (INSERM), ERI3 Cancers & Populations, Caen University Hospital, University of Caen Basse-Normandie (UCBN), Caen, France.
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Stott P. Upper gastrointestinal cancer and economic deprivation - data from a London (UK) Cancer Network. Int J Clin Pract 2009; 63:835-7. [PMID: 19490192 DOI: 10.1111/j.1742-1241.2009.02018.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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