Abstract
This study examined the impact of socioeconomic status on colorectal cancer risk, staging, and survival under the National Health Insurance (NHI) system in Taiwan. Monthly salary and education level were used as measures of socioeconomic status to observe the risk of colorectal cancer among individuals aged 40 years or above in 2006–2015 and survival outcomes of patients with colorectal cancer until the end of 2016. Data from 286,792 individuals were used in this study. Individuals with a monthly salary ≤Q1 were at a significantly lower incidence risk of colorectal cancer than those with a monthly salary >Q3 (HR = 0.80, 95% CI = 0.74–0.85), while those with elementary or lower education were at a significantly higher risk than those with junior college, university, or higher education (HR = 1.18, 95% CI = 1.06–1.31). The results show that socioeconomic status had no significant impact on colorectal cancer stage at diagnosis. Although salary was not associated with their risk of mortality, patients with colorectal cancer who had elementary or lower education incurred a significantly higher risk of mortality than those who had junior college, university, or higher education (HR = 1.39, 95% CI = 1.07–1.77). Education level is a significant determinant of the incidence risk and survival in patients with colorectal cancer, but only income significantly impacts incidence risk.
Highlights
IntroductionMost studies that measured socioeconomic status using individual data selected education level and income as variables of interest [3]
Cancer tops the list of 10 leading causes of death in Taiwan; among all cancers, colorectal cancer ranks at the top in terms of incidence and third in terms of mortality.In 2017, colorectal cancer reported an age-standardized incidence rate of 42.93 in every population of 100,000 [1] and an age-standardized mortality rate of 14.4 per 100,000 [2].Most studies that measured socioeconomic status using individual data selected education level and income as variables of interest [3]
The results revealed that socioeconomic status impacts individuals’ risk of colorectal cancer and subsequent survival but exerts no significant influence on the cancer stage at diagnosis under a universal health insurance coverage (i.e., National Health Insurance (NHI))
Summary
Most studies that measured socioeconomic status using individual data selected education level and income as variables of interest [3]. Taiwanese studies on the impact of socioeconomic status on diseases often considered such data a proxy measure of the income status of the insured [4,5,6]. The impact of socioeconomic status on the incidence, staging, and survival of colorectal cancer has been well-documented in the literature, research has yet to derive a consistent conclusion regarding the numerous impacts due to international disparities in culture and healthcare systems. Most studies have corroborated the finding that individuals with lower socioeconomic status are at higher risk of colorectal cancer [7,8,9,10,11], 4.0/)
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