Estimation of the Potentially Avoidable Excess Deaths Associated with Socioeconomic Inequalities in Cancer Survival in Germany.

Lina Jansen,Hermann Brenner,Volker Arndt,Katharina Emrich,For The German Cancer Survival Working Group Group,Bernd Holleczek,Joachim Kieschke,Hiltraud Kajüter,Cynthia Erb,Josephine Kanbach,Lars Schwettmann,Isabelle Finke,Werner Maier,Eunice Sirri,Ron Pritzkuleit

doi:10.3390/cancers13020357

Abstract

Simple SummaryIn this study, we estimate the number of avoidable deaths attributable to socioeconomic inequalities in cancer survival in Germany. We used data from epidemiological cancer registries. The German Index of Multiple Deprivation (GIMD) 2010 was used to assess deprivation on a municipality level. Results show that summed over the 25 cancer sites, 4100 annual excess deaths (3.0% of all excess deaths) could have been avoided each year in Germany during the period 2013–2016 if relative survival were in all regions comparable with the least deprived regions. Colorectal, oral and pharynx, prostate, and bladder cancer contributed the largest numbers of avoidable excess deaths. We also observed that cancer incidence was generally higher in more deprived areas. Our analyses demonstrate the importance of cancer prevention and of survival improvements in more deprived regions.Many countries have reported survival inequalities due to regional socioeconomic deprivation. To quantify the potential gain from eliminating cancer survival disadvantages associated with area-based deprivation in Germany, we calculated the number of avoidable excess deaths. We used population-based cancer registry data from 11 of 16 German federal states. Patients aged ≥15 years diagnosed with an invasive malignant tumor between 2008 and 2017 were included. Area-based socioeconomic deprivation was assessed using the quintiles of the German Index of Multiple Deprivation (GIMD) 2010 on a municipality level nationwide. Five-year age-standardized relative survival for 25 most common cancer sites and for total cancer were calculated using period analysis. Incidence and number of avoidable excess deaths in Germany in 2013–2016 were estimated. Summed over the 25 cancer sites, 4100 annual excess deaths (3.0% of all excess deaths) could have been avoided each year in Germany during the period 2013–2016 if relative survival were in all regions comparable with the least deprived regions. Colorectal, oral and pharynx, prostate, and bladder cancer contributed the largest numbers of avoidable excess deaths. Our results provide a good basis to estimate the potential of intervention programs for reducing socioeconomic inequalities in cancer burden in Germany.

Highlights

Disparities in cancer survival due to area-based deprivation have been reported in many countries and for several cancer sites showing that cancer patients living in affluent regions have better survival than those living in more deprived regions [1,2,3,4,5,6].Despite universal health insurance coverage, these disparities have been reported for Germany [7,8,9,10]
After exclusion of 8% of death certificate only (DCO) cases, 2,939,971 cancer cases were included in the survival analysis (Table 2)
For all cancer sites combined five-year age-standardized relative survival in 2013–2017 decreased gradually with increasing deprivation from 66.9%

Summary

Introduction

Disparities in cancer survival due to area-based deprivation have been reported in many countries and for several cancer sites showing that cancer patients living in affluent regions have better survival than those living in more deprived regions [1,2,3,4,5,6].Despite universal health insurance coverage, these disparities have been reported for Germany [7,8,9,10]. All German studies on socioeconomic inequalities in cancer survival, as well as most studies from other countries, used relative or absolute survival and RERs or hazard ratios as outcomes. These estimates might not be interpretable by policy makers and the public. We use instead the number of avoidable excess deaths attributed to socioeconomic inequalities in cancer survival This is an alternative and easy to interpret estimate for the potential gain of eliminating social inequalities in cancer survival. The aim of the present study is to provide an up-to-date estimate of avoidable excess deaths attributed to area-based socioeconomic inequalities in cancer survival in Germany using data from epidemiological cancer registries

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