Abstract
Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001–2015 were identified using the Victorian Cancer Registry and followed to the end of 2016. Five-year net survival and the excess risk of death due to a cancer diagnosis were estimated. People living in more disadvantaged areas had lower five-year survival than residents of less disadvantaged regions for 21 of 29 cancer types: head and neck, oesophagus, stomach, colorectum, anus/anal canal, liver, gallbladder/biliary tract, pancreas, lung, melanoma, connective/soft tissue, female breast, ovary, prostate, kidney, bladder, brain and central nervous system, unknown primary, non-Hodgkin lymphoma, multiple myeloma and leukemia. The observed lower survival in more deprived regions persisted over time, except head and neck cancer, for which the gap in survival has widened. Socio-economic inequalities in survival decreased with increasing age at diagnosis for cancers of connective/soft tissue, bladder and unknown primary. For colorectal cancer, the observed survival disadvantage in lower socio-economic regions was greater for men than for women, while for brain and central nervous system tumours, it was larger for women. Cancer survival is generally lower for residents of more socio-economically disadvantaged areas. Identifying the underlying reasons for these inequalities is important and may help to identify effective interventions to increase survival for underprivileged cancer patients.
Highlights
Survival has increased for most cancer types due to earlier diagnosis and more effective treatments. [1, 2] In parallel, there is well-documented evidence that socio-economic inequalities in cancer survival exist in high-income countries, with disadvantaged cancer patients having lower survival than their counterparts with higher socio-economic position (SEP). [3,4,5] Even though Australia has a universal health care system, socio-economic differences in cancer survival exist. [6,7,8] In 2010–2014, five-year relative survival for all cancers combined was lower for patients living in the most disadvantaged areas (55%), relative to the least disadvantaged areas (67%)
For cancer cases diagnosed in 2009–2015 this was Statistical Area Level 1 (SA1; mean population size of 400 persons), [16] and for cases diagnosed in 2001–2008, this was Collection District (CD; mean of 225 dwellings)
A total of 331,419 Victorian residents diagnosed between January 1, 2001 and December 30, 2015 with one of the 29 incident cancers considered were included in the analyses (Fig 1)
Summary
Survival has increased for most cancer types due to earlier diagnosis and more effective treatments. [1, 2] In parallel, there is well-documented evidence that socio-economic inequalities in cancer survival exist in high-income countries, with disadvantaged cancer patients having lower survival than their counterparts with higher socio-economic position (SEP). [3,4,5] Even though Australia has a universal health care system, socio-economic differences in cancer survival exist. [6,7,8] In 2010–2014, five-year relative survival for all cancers combined was lower for patients living in the most disadvantaged areas (55%), relative to the least disadvantaged areas (67%). [9] The largest gaps were found for cancers of the head and neck, colorectum, cervix, kidney, prostate as well as non-Hodgkin lymphoma. [9]Australian studies that have investigated socio-economic differences in cancer survival have not used socio-economic status-specific life tables to estimate relative survival [8, 10] and may have provided biased survival estimates by overestimating relative survival gaps, as the expected background mortality of more disadvantaged people is likely to be underestimated in general population life tables (i.e. more deaths than should have been were attributed to cancer).Several studies, including one from Australia, have observed differences in cancer survival by sex; men generally have lower survival than women for most cancers, [11,12,13,14,15] but it is not clear whether socio-economic inequalities in cancer survival differ between men and women. Australian studies that have investigated socio-economic differences in cancer survival have not used socio-economic status-specific life tables to estimate relative survival [8, 10] and may have provided biased survival estimates by overestimating relative survival gaps, as the expected background mortality of more disadvantaged people is likely to be underestimated in general population life tables (i.e. more deaths than should have been were attributed to cancer). We aimed to assess differences in cancer survival by arealevel socio-economic disadvantage using the Victorian Cancer Registry data. We investigated whether these inequalities are widening or narrowing over time and examined differences by age at diagnosis, time since diagnosis and sex
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