Effects of socioeconomic and geographic variations on survival for adult glioma in England and Wales

Abstract

Background To investigate the effects of SES and geographic variations on survival for adult patients with glioma, we analyzed data from 30 489 patients from the Cancer Registry in England and Wales. Methods Median survival and CSRs for 8 variables (age, sex, morphology, World Health Organization [WHO] grade, tumor site, SES, geographic regions, and periods of diagnosis) are calculated using the Kaplan-Meier method. Distributions among different variables are compared using χ 2 test. Cox regressions are performed for estimating HRs to death. Results The median survival and the 1-, 5-, and 10-year CSR in this population are 0.42 years, 29.1%, 12.0%, and 7.7%, respectively. There is a gradient in SES from the south to the north ( χ 2 test, P < .001) and a gradual increment in higher SES from the early to the recent period ( χ 2 test, P < .001). Mono- and multivariate analyses reveal that all the 8 variables influenced the survival ( P < .05). Age (HR, 1.04 per year from 15 years, P < .001), WHO grade (1.21 per grade from grade I, P < .001), and morphology (HR from 1.23 to 1.89, compared with ependymoma, P < .05) are the most influential factors. However, there are also independent effects from SES (HR, 1.03 per quintile of deprivation, P < .001) and geographic regions (HR, 1.10 for outside southern England; P < .001) on the survival. Conclusions Although age and tumor characteristics (morphology, WHO grade, tumor site) are well-known prognostic factors, SES and geographic variations also play a slight but significant role, and for more cost-effective allocation of health resources, alleviation on these 2 modifiable factors should be considered.