Abstract
BackgroundAssociation between cancer survival and socioeconomic status has been reported in various countries but it has never been studied in Portugal. We aimed here to study the role of education and socioeconomic deprivation level on survival from colorectal cancer in the North Region of Portugal using a population-based cancer registry dataset.MethodsWe analysed a cohort of patients aged 15–84 years, diagnosed with a colorectal cancer in the North Region of Portugal between 2000 and 2002. Education and socioeconomic deprivation level was assigned to each patient based on their area of residence. We measured socioeconomic deprivation using the recently developed European Deprivation Index. Net survival was estimated using Pohar-Perme estimator and age-adjusted excess hazard ratios were estimated using parametric flexible models. Since no deprivation-specific life tables were available, we performed a sensitivity analysis to test the robustness of the results to life tables adjusted for education and socioeconomic deprivation level.ResultsA total of 4,105 cases were included in the analysis. In male patients (56.3 %), a pattern of worse 5- and 10-year net survival in the less educated (survival gap between extreme education groups: -7 % and -10 % at 5 and 10 years, respectively) and more deprived groups (survival gap between extreme EDI groups: -5 % both at 5 and 10 years) was observed when using general life tables. No such clear pattern was found among female patients. In both sexes, when likely differences in background mortality by education or deprivation were accounted for in the sensitivity analysis, any differences in net survival between education or deprivation groups vanished.ConclusionsOur study shows that observed differences in survival by education and EDI level are most likely attributable to inequalities in background survival. Also, it confirms the importance of using the relevant life tables and of performing sensitivity analysis when evaluating socioeconomic inequalities in cancer survival. Comparison studies of different healthcare systems organization should be performed to better understand its influence on cancer survival inequalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2639-9) contains supplementary material, which is available to authorized users.
Highlights
Association between cancer survival and socioeconomic status has been reported in various countries but it has never been studied in Portugal
Scenario S2 corresponds to a difference in life expectancy as small as 3.1 years between the most educated and least educated categories in the general population, a difference which is likely to underestimate the real disparities in background mortality between socioeconomic or education groups in Portugal
To the best of our knowledge, this is the first population-based study to address the question of socioeconomic inequalities in survival from colorectal cancer in Portugal
Summary
Association between cancer survival and socioeconomic status has been reported in various countries but it has never been studied in Portugal. We aimed here to study the role of education and socioeconomic deprivation level on survival from colorectal cancer in the North Region of Portugal using a population-based cancer registry dataset. Association between survival from colon or rectal cancer and socioeconomic status (SES) has been repeatedly reported in various countries [5, 6]. Not reflecting the individual condition of each patient, ecological measures are informative enough to evaluate the association between SES and survival from cancer, as long as the population size of the areas considered is sufficiently small and homogeneous relatively to the SES measure [13]. The index is derived from countryspecific census variables that are most associated with the variables of the survey European Union-Statistics on Income and Living Conditions EU-SILC [17]
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