Association Between Socioeconomic Deprivation And Cancer Incidence And Outcomes Among English CCGS

Abstract

It is well established that socioeconomic deprivation is associated with increased cancer incidence and poorer outcomes. In England, clinical commissioning group (CCG) funding is partly based on deprivation. The objective of this study was to assess the relationship between deprivation and the incidence and outcomes of breast, lung and colorectal cancers within CCG populations. CCG-level data for breast, lung and colorectal cancers, along with index of multiple deprivation (IMD) scores, were extracted using NHS England’s Cancer and Tumours Focus Pack Tool. Pearson correlation coefficients were used to determine the relationship between IMD scores and breast, lung, and colorectal cancer incidence, one-year survival, early-stage detection (stage 1 or 2) and under-75 mortality rates. Data were available from 209 CCGs. The incidences of breast and lung cancers were positively correlated with IMD score (R=0.39 [p<0.001] and R=0.78 [p<0.001], respectively). Early-stage detection was also positively correlated with IMD score for all cancer types (R=0.19 [p<0.01], R=0.18 [p<0.01] and R=0.25 [p<0.001] for breast, colorectal and lung cancers, respectively). While colorectal cancer-related under-75 mortality was positively correlated with IMD score (R=0.28 [p<0.001]), no correlation was observed between breast and lung cancer mortality and IMD score (R=0.05 [p=0.50] and R=0.05 [p=0.50], respectively). There was also no correlation between IMD score and colorectal cancer incidence (R=0.08 [p=0.27]) or one-year survival for lung cancer (R=0.02 [P=0.73]). However, one-year survival was negatively correlated with IMD score for breast and colorectal cancers (R=0.37 [p<0.001] and R=0.46 [P<0.001], respectively). Despite the well-established link between deprivation and cancer incidence and poorer outcomes, CCG-level data do not always reflect this. Of note was the positive correlation between deprivation and early detection, which is unexpected given the lower uptake of cancer screening in more deprived areas. These data suggest that other factors exist within CCG populations that may affect outcomes.