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Becerra-Tomás N, Markozannes G, Cariolou M, Balducci K, Vieira R, Kiss S, Aune D, Greenwood DC, Dossus L, Copson E, Renehan AG, Bours M, Demark-Wahnefried W, Hudson MM, May AM, Odedina FT, Skinner R, Steindorf K, Tjønneland A, Velikova G, Baskin ML, Chowdhury R, Hill L, Lewis SJ, Seidell J, Weijenberg MP, Krebs J, Cross AJ, Tsilidis KK, Chan DSM. Post-diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2024; 155:400-425. [PMID: 38692659 DOI: 10.1002/ijc.34905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024]
Abstract
The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.
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Affiliation(s)
- Nerea Becerra-Tomás
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sonia Kiss
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martijn Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Rajiv Chowdhury
- Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Lynette Hill
- World Cancer Research Fund International, London, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jaap Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - John Krebs
- Department of Biology, University of Oxford, Oxford, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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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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Díez JJ, Iglesias P. Prevalence of thyroid dysfunction and its relationship to income level and employment status: a nationwide population-based study in Spain. Hormones (Athens) 2023; 22:243-252. [PMID: 36805924 DOI: 10.1007/s42000-023-00435-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE The influence of socioeconomic conditions on the prevalence of thyroid dysfunction in the population has been scarcely studied to date. The aim of this study has been to evaluate the influence of income level and employment status on the prevalence of hypothyroidism and hyperthyroidism. METHODS A cross-sectional study was performed using the population-based database BDCAP (Base de Datos Clínicos de Atención Primaria, Primary Care Clinical Database) to analyze the prevalence of thyroid dysfunction in the Spanish population classified by income groups and employment status. RESULTS Of the 40,613,229 people registered in the BDCAP in 2020, there were 2,596,041 (6.39%) with a diagnosis of hypothyroidism and 418,722 (1.03%) with hyperthyroidism. The prevalence of hypothyroidism in people with high income (≥ 100,000 euros/year), medium income (18,000-99,999 euros/year), low income (< 18,000 euros/year), and very low income were, respectively, 4.23%, 5.74%, 6.75%, and 7.01% (P < 0.001). The prevalence of hyperthyroidism in the same income groups also showed an increasing trend as income decreased (0.65%, 0.94%, 1.08%, and 1.10%; P < 0.001). Unemployed people had higher frequencies of hypothyroidism (7.35%) and hyperthyroidism (1.22%) than working people (5.80 and 1.00%, respectively) and inactive people (4.21 and 0.52%, respectively; P < 0.001). CONCLUSION Socioeconomic conditions are related to the prevalence of thyroid dysfunction. Low-income or unemployed people have a higher frequency of both hypothyroidism and hyperthyroidism.
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Affiliation(s)
- Juan J Díez
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain.
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain.
| | - Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Chan DS, Vieira R, Abar L, Aune D, Balducci K, Cariolou M, Greenwood DC, Markozannes G, Nanu N, Becerra‐Tomás N, Giovannucci EL, Gunter MJ, Jackson AA, Kampman E, Lund V, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley‐Gieser D, Mitrou P, Wiseman M, Cross AJ, Riboli E, Clinton SK, McTiernan A, Norat T, Tsilidis KK. Postdiagnosis body fatness, weight change and breast cancer prognosis: Global Cancer Update Program (CUP global) systematic literature review and meta-analysis. Int J Cancer 2023; 152:572-599. [PMID: 36279884 PMCID: PMC10092239 DOI: 10.1002/ijc.34322] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 07/29/2022] [Accepted: 09/05/2022] [Indexed: 02/01/2023]
Abstract
Previous evidence on postdiagnosis body fatness and mortality after breast cancer was graded as limited-suggestive. To evaluate the evidence on body mass index (BMI), waist circumference, waist-hip-ratio and weight change in relation to breast cancer prognosis, an updated systematic review was conducted. PubMed and Embase were searched for relevant studies published up to 31 October, 2021. Random-effects meta-analyses were conducted to estimate summary relative risks (RRs). The evidence was judged by an independent Expert Panel using pre-defined grading criteria. One randomized controlled trial and 225 observational studies were reviewed (220 publications). There was strong evidence (likelihood of causality: probable) that higher postdiagnosis BMI was associated with increased all-cause mortality (64 studies, 32 507 deaths), breast cancer-specific mortality (39 studies, 14 106 deaths) and second primary breast cancer (11 studies, 5248 events). The respective summary RRs and 95% confidence intervals per 5 kg/m2 BMI were 1.07 (1.05-1.10), 1.10 (1.06-1.14) and 1.14 (1.04-1.26), with high between-study heterogeneity (I2 = 56%, 60%, 66%), but generally consistent positive associations. Positive associations were also observed for waist circumference, waist-hip-ratio and all-cause and breast cancer-specific mortality. There was limited-suggestive evidence that postdiagnosis BMI was associated with higher risk of recurrence, nonbreast cancer deaths and cardiovascular deaths. The evidence for postdiagnosis (unexplained) weight or BMI change and all outcomes was graded as limited-no conclusion. The RCT showed potential beneficial effect of intentional weight loss on disease-free-survival, but more intervention trials and well-designed observational studies in diverse populations are needed to elucidate the impact of body composition and their changes on breast cancer outcomes.
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Affiliation(s)
- Doris S.M. Chan
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Rita Vieira
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Leila Abar
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Dagfinn Aune
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of NutritionBjørknes University CollegeOsloNorway
- Department of Endocrinology, Morbid Obesity and Preventive MedicineOslo University HospitalOsloNorway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Katia Balducci
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Margarita Cariolou
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Darren C. Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Georgios Markozannes
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
| | - Neesha Nanu
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Nerea Becerra‐Tomás
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Edward L. Giovannucci
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
- Department of Nutrition, Harvard T. H. Chan School of Public HealthBostonMassachusettsUSA
| | - Marc J. Gunter
- Nutrition and Metabolism Section, International Agency for Research on CancerLyonFrance
| | - Alan A. Jackson
- Faculty of Medicine, School of Human Development and HealthUniversity of SouthamptonSouthamptonUK
- National Institute of Health Research Cancer and Nutrition CollaborationSouthamptonUK
| | - Ellen Kampman
- Division of Human Nutrition and HealthWageningen University & ResearchWageningenThe Netherlands
| | - Vivien Lund
- World Cancer Research Fund InternationalLondonUK
| | - Kate Allen
- World Cancer Research Fund InternationalLondonUK
| | | | - Helen Croker
- World Cancer Research Fund InternationalLondonUK
| | | | | | | | | | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Steven K. Clinton
- Division of Medical Oncology, The Department of Internal MedicineCollege of Medicine and Ohio State University Comprehensive Cancer Center, Ohio State UniversityColumbusOhioUSA
| | - Anne McTiernan
- Division of Public Health SciencesFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Teresa Norat
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- World Cancer Research Fund InternationalLondonUK
| | - Konstantinos K. Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
- Department of Hygiene and EpidemiologyUniversity of Ioannina Medical SchoolIoanninaGreece
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Park HA, Vaca FE, Jung-Choi K, Park H, Park JO. Area-Level Socioeconomic Inequalities in Intracranial Injury-Related Hospitalization in Korea: A Retrospective Analysis of Data From Korea National Hospital Discharge Survey 2008-2015. J Korean Med Sci 2023; 38:e38. [PMID: 36718564 PMCID: PMC9886526 DOI: 10.3346/jkms.2023.38.e38] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/14/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Although inequality in traumatic brain injury (TBI) by individual socioeconomic status (SES) exists, interventions to modify individual SES are difficult. However, as interventions for area-based SES can affect the individual SES, monitoring or public health intervention can be planned. We analyzed the effect of area-based SES on hospitalization for TBI and revealed yearly inequality trends to provide a basis for health intervention. METHODS We included patients who were hospitalized due to intracranial injuries (ICIs) between 2008 and 2015 as a measure of severe TBI with data provided by the Korea National Hospital Discharge Survey. Area-based SES was synthesized using the 2010 census data. We assessed inequalities in ICI-related hospitalization rates using the relative index of inequality and the slope index of inequality for the periods 2008-2009, 2010-2011, 2012-2013, and 2014-2015. We analyzed the trends of these indices for the observation period by age and sex. RESULTS The overall relative indices of inequality for each 2-year period were 1.82 (95% confidence interval, 1.5-2.3), 1.97 (1.6-2.5), 2.01 (1.6-2.5), and 2.01 (1.6-2.5), respectively. The overall slope indices of inequality in each period were 38.74 (23.5-54.0), 36.75 (21.7-51.8), 35.65 (20.7-50.6), and 43.11 (27.6-58.6), respectively. The relative indices of inequality showed a linear trend for men (P = 0.006), which was most evident in the ≥ 65-year age group. CONCLUSION Inequality in hospitalization for ICIs by area-based SES tended to increase during the observation period. Practical preventive interventions and input in healthcare resources for populations with low area-based SES are likely needed.
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Affiliation(s)
- Hang A Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, Korea
| | - Federico E Vaca
- Department of Emergency Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Kyunghee Jung-Choi
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, Korea
| | - Ju Ok Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.
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Tron L, Remontet L, Fauvernier M, Rachet B, Belot A, Launay L, Merville O, Molinié F, Dejardin O, Launoy G. Is the Social Gradient in Net Survival Observed in France the Result of Inequalities in Cancer-Specific Mortality or Inequalities in General Mortality? Cancers (Basel) 2023; 15:659. [PMID: 36765616 PMCID: PMC9913401 DOI: 10.3390/cancers15030659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In cancer net survival analyses, if life tables (LT) are not stratified based on socio-demographic characteristics, then the social gradient in mortality in the general population is ignored. Consequently, the social gradient estimated on cancer-related excess mortality might be inaccurate. We aimed to evaluate whether the social gradient in cancer net survival observed in France could be attributable to inaccurate LT. METHODS Deprivation-specific LT were simulated, applying the social gradient in the background mortality due to external sources to the original French LT. Cancer registries' data from a previous French study were re-analyzed using the simulated LT. Deprivation was assessed according to the European Deprivation Index (EDI). Net survival was estimated by the Pohar-Perme method and flexible excess mortality hazard models by using multidimensional penalized splines. RESULTS A reduction in net survival among patients living in the most-deprived areas was attenuated with simulated LT, but trends in the social gradient remained, except for prostate cancer, for which the social gradient reversed. Flexible modelling additionally showed a loss of effect of EDI upon the excess mortality hazard of esophagus, bladder and kidney cancers in men and bladder cancer in women using simulated LT. CONCLUSIONS For most cancers the results were similar using simulated LT. However, inconsistent results, particularly for prostate cancer, highlight the need for deprivation-specific LT in order to produce accurate results.
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Affiliation(s)
- Laure Tron
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
| | - Laurent Remontet
- Service de Biostatistique—Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France
- University of Lyon, 69000 Lyon, France
- University of Lyon 1, 69100 Villeurbanne, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Mathieu Fauvernier
- Service de Biostatistique—Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, 69000 Lyon, France
- University of Lyon, 69000 Lyon, France
- University of Lyon 1, 69100 Villeurbanne, France
- Équipe Biostatistique-Santé, Laboratoire de Biométrie et Biologie Évolutive, CNRS, UMR 5558, 69100 Villeurbanne, France
| | - Bernard Rachet
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Ludivine Launay
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
| | - Ophélie Merville
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
| | - Florence Molinié
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Loire-Atlantique-Vendée Cancer Registry, 44000 Nantes, France
- Centre d’Epidémiologie et de Recherche en santé des POPulations (CERPOP) UMR1295, Université de Toulouse Paul Sabatier, Inserm, 31000 Toulouse, France
| | - Olivier Dejardin
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
- Research Department, Caen University Hospital Centre, 14000 Caen, France
| | - Francim Group
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
| | - Guy Launoy
- ANTICIPE U1086 INSERM-UCN, Equipe Labellisée Ligue Contre le Cancer, Centre François Baclesse, Normandie Université UNICAEN, 14000 Caen, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Research Department, Caen University Hospital Centre, 14000 Caen, France
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Devos S, Khettab M, Chirpaz E. Survival of adult patients with solid cancer in Reunion Island, 1998–2014. Bull Cancer 2022; 109:436-444. [DOI: 10.1016/j.bulcan.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212164. [PMID: 34831918 PMCID: PMC8625901 DOI: 10.3390/ijerph182212164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022]
Abstract
This study examined the impact of socioeconomic status on colorectal cancer risk, staging, and survival under the National Health Insurance (NHI) system in Taiwan. Monthly salary and education level were used as measures of socioeconomic status to observe the risk of colorectal cancer among individuals aged 40 years or above in 2006-2015 and survival outcomes of patients with colorectal cancer until the end of 2016. Data from 286,792 individuals were used in this study. Individuals with a monthly salary ≤Q1 were at a significantly lower incidence risk of colorectal cancer than those with a monthly salary >Q3 (HR = 0.80, 95% CI = 0.74-0.85), while those with elementary or lower education were at a significantly higher risk than those with junior college, university, or higher education (HR = 1.18, 95% CI = 1.06-1.31). The results show that socioeconomic status had no significant impact on colorectal cancer stage at diagnosis. Although salary was not associated with their risk of mortality, patients with colorectal cancer who had elementary or lower education incurred a significantly higher risk of mortality than those who had junior college, university, or higher education (HR = 1.39, 95% CI = 1.07-1.77). Education level is a significant determinant of the incidence risk and survival in patients with colorectal cancer, but only income significantly impacts incidence risk.
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Noh E, Kang HY, Bahk J, Kim I, Khang YH. Cancer-free Life Expectancy in Small Administrative Areas in Korea and Its Associations with Regional Health Insurance Premiums. J Korean Med Sci 2021; 36:e269. [PMID: 34725977 PMCID: PMC8560318 DOI: 10.3346/jkms.2021.36.e269] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/06/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND To determine the priorities and resource allocation of community cancer-related health policies, it is necessary to measure cancer-related health indicators and the burden of cancer by region. This study calculated the cancer-free life expectancy at the eup/myeon/dong level (small administrative units in South Korea) for the first time, and analyzed its association with regional health insurance premiums. METHODS We used aggregate data from the 2008-2017 National Health Information Database provided by the National Health Insurance Service. Cancer-free life expectancy was calculated by applying Sullivan's method to mortality and cancer prevalence by age group and sex for the 10-year period in 3,396 eups/myeons/dongs. Correlation analyses were performed to analyze the relationship between cancer-free life expectancy and regional health insurance premiums. RESULTS Cancer-free life expectancy in eups/myeons/dongs of metropolitan areas tended to be higher than in non-metropolitan areas. However, some eups/myeons/dongs of non-metropolitan areas showed quite a high cancer-free life expectancy, especially for females. The median values of differences between cancer-free life expectancy and life expectancy at the eup/myeon/dong level (total: 1.6 years, male: 1.8 years, female: 1.4 years) indicated that a person's healthy life can be shortened by a number of years due to cancer. The association of cancer-free life expectancy by eup/myeon/dong with the regional health insurance premium was statistically significant (β = 1.0, P < 0.001) and more prominent for males (β = 1.3, P < 0.001) than for females (β = 0.5, P < 0.001). The relationship between the regional health insurance premium and the burden of cancer (life expectancy minus cancer-free life expectancy) was also statistically significant (β = 0.2 for the total population, β = 0.2 for males, and β = 0.1 for females, all P values < 0.001). CONCLUSION This study showed a significant regional gap with regard to cancer-free life expectancy and the burden of cancer at the eup/myeon/dong level. This work makes a meaningful contribution by presenting new and firsthand summary measures of cancer-related health across small areas in Korea. The results will also help the authorities to evaluate the effectiveness of local cancer management projects in small administrative areas and determine regional priorities for implementing cancer control policies.
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Affiliation(s)
- Eunjeong Noh
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
| | - Hee-Yeon Kang
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Jinwook Bahk
- Department of Public Health, Keimyung University, Daegu, Korea
| | - Ikhan Kim
- Department of Medical Humanities and Social Medicine, Kosin University College of Medicine, Busan, Korea
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
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10
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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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11
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Lee HE, Kim EA, Zaitsu M, Kawachi I. Occupational disparities in survival in Korean women with cancer: a nationwide registry linkage study. BMJ Open 2020; 10:e039259. [PMID: 32912993 PMCID: PMC7485248 DOI: 10.1136/bmjopen-2020-039259] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES We sought to examine occupational disparities in survival among Korean women diagnosed with cancer. DESIGN Population-based, registry-linkage study. SETTING South Korea. PARTICIPANTS Our study population comprised female workers registered in the Korean national employment insurance programme during 1995-2000 and diagnosed with cancer between 1995 and 2008. A total of 61 110 women with cancer diagnoses was included in analysis. The occupation was categorised into four groups: (1) managers, professionals and technical workers, (2) clerks, (3) service/sales workers and (4) blue-collar workers. PRIMARY AND SECONDARY OUTCOME MEASURE Study population were linked to the national death registry until 2009. HRs for mortality adjusting for age and year of diagnosis were calculated in the study sample and subgroups with 10 specific cancer sites including thyroid, breast, stomach, cervix, colon or lung cancer using managers, professionals and technical workers as the reference. RESULTS Women in service/sales (HR 1.25, 95% CI 1.15 to 1.35) and blue-collar occupations (HR 1.34, 95% CI 1.25 to 1.44) had poorer survival for all cancer sites combined, while blue-collar workers showed poorer survival for lung (HR 1.41, 95% CI 1.14 to 1.77), breast (HR 1.28, 95% CI 1.06 to 1.54), cervical cancer (HR 1.42, 95% CI 1.02 to 2.06) and non-Hodgkin's lymphoma (HR 1.69, 95% CI 1.09 to 2.77) compared with women in professional and managerial positions. CONCLUSION We found substantial and significant inequalities in overall survival by the occupational group among Korean women with cancer, even in the context of universal access to cancer screening and treatment.
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Affiliation(s)
- Hye-Eun Lee
- Korea Institute of Labor Safety and Health, Seoul, Republic of Korea
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Eun-A Kim
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, Republic of Korea
| | - Masayoshi Zaitsu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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12
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Luo R, Liu D, Ye S, Tang H, Zhu W, He P, Tang C, Li T. Short- and long-term outcomes of totally robotic versus robotic-assisted radical distal gastrectomy for advanced gastric cancer: a mono-institution retrospective study. World J Surg Oncol 2019; 17:188. [PMID: 31711530 PMCID: PMC6849191 DOI: 10.1186/s12957-019-1722-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/09/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose By comparing short- and long-term outcomes following totally robotic radical distal gastrectomy (TRDG) and robotic-assisted radical distal gastrectomy (RADG), we aimed to assess in which modus operandi patients will benefit more. Methods From January 2015 to May 2019, we included 332 patients undergone RADG (237) and TRDG (95). Based on the propensity score matching (PSM), inclusion and exclusion criteria, 246 patients were finally included in the propensity score-matched cohort including RADG group (164) and TRDG group (82). We then compared the short- and long-term outcomes following both groups. Results Propensity score-matched cohort revealed no significant differences in both groups. Intra-abdominal bleeding, time to pass flatus, postoperative activity time, length of incision hospital stays, and stress response were significantly less in TRDG group than in RADG group. We observed 30 complications in RADG group while 13 complications in TRDG group. There were no significant differences in TRDG group and RADG group in terms of operation time, time for anastomosis, proximal resection, distal resection margin, number of lymph node resection, and total hospitalization cost. Both 3-year overall survival and 3-year disease-free survival were comparable in both groups. Conclusions TRDG is a safe and feasible modus operandi profiting from short- and long-term outcomes compared with RADG. As surgeons improving their professional skills, TRDG could serve as the standard procedure for distal locally advanced gastric cancer with D2 lymphadenectomy.
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Affiliation(s)
- Rui Luo
- Medical College of Nanchang University, Nanchang, 330000, China
| | - Dongning Liu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Shanping Ye
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Hechun Tang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Weiquan Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Penghui He
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Cheng Tang
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Taiyuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330000, China.
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13
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Kim Y, Je Y, Giovannucci EL. Association between Alcohol Consumption and Survival in Colorectal Cancer: A Meta-analysis. Cancer Epidemiol Biomarkers Prev 2019; 28:1891-1901. [PMID: 31399475 DOI: 10.1158/1055-9965.epi-19-0156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/19/2019] [Accepted: 08/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Although an association between alcohol consumption and risk of colorectal cancer is well established, little is known about the association between alcohol consumption and colorectal cancer survival. We conducted a meta-analysis of prospective cohort studies to quantitatively assess this association. METHODS Data searches were performed using PubMed and ISI Web of Science databases through December 2018. We estimated pooled RRs with 95% confidence intervals (CI) using random-effects models. RESULTS Twelve studies with 32,846 patients with colorectal cancer were included in the meta-analysis. Compared with no alcohol consumption, light (RR = 0.87; 95% CI, 0.81-0.94) and moderate (RR = 0.92; 95% CI, 0.85-1.00) prediagnostic alcohol consumption were associated with lower risk of all-cause mortality. Light prediagnostic alcohol consumption was associated with lower risk of colorectal cancer-specific mortality (RR = 0.87; 95% CI, 0.78-0.98). However, heavy prediagnostic alcohol consumption was not significantly associated with colorectal cancer survival. In a dose-response analysis, a nonlinear association between prediagnostic alcohol consumption and all-cause mortality was observed (P nonlinearity = 0.0025), showing the reduction in RR at <30 g/day of alcohol consumption. By type of alcohol, wine consumption was associated with lower risk of mortality from all-causes and colorectal cancer, but a positive association was observed between moderate liquor consumption and all-cause mortality. There was no association between postdiagnostic alcohol consumption and colorectal cancer survival. CONCLUSIONS Light and moderate prediagnostic alcohol consumption were associated with better survival in colorectal cancer. IMPACT Our findings suggest that light and moderate alcohol consumption may be associated with better survival in colorectal cancer, but further studies are warranted.
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Affiliation(s)
- Youngyo Kim
- Department of Cancer Biomedical Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Youjin Je
- Department of Food and Nutrition, Kyung Hee University, Seoul, South Korea.
| | - Edward L Giovannucci
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts.,Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts
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14
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Wang Z, Gu X, Thrift AP. Factors associated with favorable survival outcomes for Asians with hepatocellular carcinoma: A sequential matching cohort study. PLoS One 2019; 14:e0214721. [PMID: 30943273 PMCID: PMC6447218 DOI: 10.1371/journal.pone.0214721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 03/19/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Overall 5-year survival rates for patients diagnosed with hepatocellular carcinoma (HCC) are poor, but vary by race/ethnicity. We undertook a comprehensive assessment of underlying contributing factors to the favorable survival outcomes of HCC among Asians compared with non-Hispanic whites (NHW). METHODS We identified 1,284 Asian and 7,072 NHW patients newly diagnosed with HCC between 1994 and 2011 in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. We used a novel three-step sequential matching approach to identify demographic, presentation and treatment factors that may explain survival differences between Asians and NHWs. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for the association between Asian race and risk of HCC-related mortality were estimated using Cox proportional hazards models. RESULTS The absolute difference in 5-year survival rates between Asians and NHWs was 8.4% (95% CI: 4.6%-12.0%) in the demographics match analysis. The disparity remained unchanged after additionally matching on stage, grade and comorbidities in the presentation match analysis. However, in the treatment match analysis, which accounts for differences in demographic, presentation and treatment factors, the absolute difference in 5-year survival rates was reduced to 5.8% (95% CI: 2.6%-9.3%). Treatment differences explained more of survival disparity in Asian and NHW patients with localized disease than for those with regional or distant stage HCC. CONCLUSIONS Asian patients with HCC continue to have more favorable survival outcomes than NHWs with HCC. This persistent disparity seems to be more related to treatment differences than to differences in presentation characteristics including stage.
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Affiliation(s)
- Zhensheng Wang
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Xiangjun Gu
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
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15
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Finke I, Behrens G, Weisser L, Brenner H, Jansen L. Socioeconomic Differences and Lung Cancer Survival-Systematic Review and Meta-Analysis. Front Oncol 2018; 8:536. [PMID: 30542641 PMCID: PMC6277796 DOI: 10.3389/fonc.2018.00536] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/31/2018] [Indexed: 12/14/2022] Open
Abstract
Background: The impact of socioeconomic differences on cancer survival has been investigated for several cancer types showing lower cancer survival in patients from lower socioeconomic groups. However, little is known about the relation between the strength of association and the level of adjustment and level of aggregation of the socioeconomic status measure. Here, we conduct the first systematic review and meta-analysis on the association of individual and area-based measures of socioeconomic status with lung cancer survival. Methods: In accordance with PRISMA guidelines, we searched for studies on socioeconomic differences in lung cancer survival in four electronic databases. A study was included if it reported a measure of survival in relation to education, income, occupation, or composite measures (indices). If possible, meta-analyses were conducted for studies reporting on individual and area-based socioeconomic measures. Results: We included 94 studies in the review, of which 23 measured socioeconomic status on an individual level and 71 on an area-based level. Seventeen studies were eligible to be included in the meta-analyses. The meta-analyses revealed a poorer prognosis for patients with low individual income (pooled hazard ratio: 1.13, 95 % confidence interval: 1.08–1.19, reference: high income), but not for individual education. Group comparisons for hazard ratios of area-based studies indicated a poorer prognosis for lower socioeconomic groups, irrespective of the socioeconomic measure. In most studies, reported 1-, 3-, and 5-year survival rates across socioeconomic status groups showed decreasing rates with decreasing socioeconomic status for both individual and area-based measures. We cannot confirm a consistent relationship between level of aggregation and effect size, however, comparability across studies was hampered by heterogeneous reporting of socioeconomic status and survival measures. Only eight studies considered smoking status in the analysis. Conclusions: Our findings suggest a weak positive association between individual income and lung cancer survival. Studies reporting on socioeconomic differences in lung cancer survival should consider including smoking status of the patients in their analysis and to stratify by relevant prognostic factors to further explore the reasons for socioeconomic differences. A common definition for socioeconomic status measures is desirable to further enhance comparisons between nations and across different levels of aggregation.
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Affiliation(s)
- Isabelle Finke
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Gundula Behrens
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Linda Weisser
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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16
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Nam HS. Area-level Socioeconomic Deprivation Affect Individual Cancer Mortality in Korea. J Korean Med Sci 2017; 32:1905. [PMID: 29115067 PMCID: PMC5680484 DOI: 10.3346/jkms.2017.32.12.1905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 10/26/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hae Sung Nam
- Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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