Abstract
Background: Socioeconomic inequalities in colorectal cancer survival have been observed in many countries. To overcome these inequalities, the underlying reasons must be disclosed.Methods: Using data from three population-based clinical cancer registries in Germany, we investigated whether associations between area-based socioeconomic deprivation and survival after colorectal cancer depended on patient-, tumor- or treatment-related factors. Patients with a diagnosis of colorectal cancer in 2000–2015 were assigned to one of five deprivation groups according to the municipality of the place of residence using the German Index of Multiple Deprivation. Cox proportional hazards regression models with various levels of adjustment and stratifications were applied.Results: Among 38,130 patients, overall 5-year survival was 4.8% units lower in the most compared to the least deprived areas. Survival disparities were strongest in younger patients, in rectal cancer patients, in stage I cancer, in the latest period, and with longer follow-up. Disparities persisted after adjustment for stage, utilization of surgery and screening colonoscopy uptake rates. They were mostly still present when restricting to patients receiving treatment according to guidelines.Conclusion: We observed socioeconomic inequalities in colorectal cancer survival in Germany. Further studies accounting for potential differences in non-cancer mortality and exploring treatment patterns in detail are needed.
Highlights
Colorectal cancer (CRC) is the third most common cancer worldwide with more than 1.8 million cases in 2018 [1]
In Germany, about 61,000 persons were diagnosed with CRC in 2014, [2] and 5-year relative survival for CRC was estimated to be 64% for patients diagnosed in 2007–2010 in Germany [3]
Previous studies have elucidated socioeconomic inequalities in survival after CRC [4, 5]. These inequalities were observed for socioeconomic status measures on individual as well as area level and in countries with and without a universal health insurance system
Summary
Colorectal cancer (CRC) is the third most common cancer worldwide with more than 1.8 million cases in 2018 [1]. Previous studies have elucidated socioeconomic inequalities in survival after CRC [4, 5] These inequalities were observed for socioeconomic status measures on individual as well as area level and in countries with and without a universal health insurance system. Three studies on the association of area-based socioeconomic deprivation and cancer survival in Germany have been conducted [9,10,11]. In the first multistate study, area-based socioeconomic deprivation was measured on the district level (median population: ≈126,000 residents) and was significantly associated with relative survival for many cancer sites [10]. In a recent study on lung cancer, area-based socioeconomic inequalities in survival were reported, which were stronger in earlier stages [11].
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