Abstract
BackgroundLittle is known about occupational class differences in pancreatic cancer survival.MethodsUsing a population‐based cancer registry in Japan, 3 578 patients with incident pancreatic cancer (1970‐2011) were followed up for 5 years (median follow‐up time 0.42 years). We classified patients into four occupational classes based on their longest‐held jobs: white‐collar (professional and managers), service, blue‐collar, and those not actively employed. Using white‐collar class as the reference group, hazard ratios (HRs) and 95% confidence intervals (CIs) for overall death were estimated by Cox proportional hazard model. Covariates included age, sex, and year of diagnosis. Prognostic variables (pathology, stage, and treatment) and smoking behaviors were additionally adjusted as possible mediating factors.ResultsOverall survival was poor in this population (median, 0.50 and 0.33 years in white‐collar and service classes, respectively). Compared with white‐collar patients, survival was significantly poorer across all occupational classes, most pronounced in the service worker group: mortality HRs ranged from 1.11 (95% CI 1.00‐1.24) in blue‐collar workers to 1.24 (95% CI 1.12‐1.37) in service workers. Even after controlling for potential mediating factors, service workers showed worse survival.ConclusionWe documented occupational class disparities in pancreatic cancer survival in Japan. Even in the setting of lethal prognostic cancer with universal health coverage, high‐occupational class groups may enjoy a health advantage.
Highlights
Pancreatic cancer accounts for ~4% of cancer‐related deaths worldwide, and the global burden of pancreatic cancer is increasing.[1]
According to the theory of “SES as a fundamental cause of disease” advocated by Link and Phelan (1995), high‐socioeconomic status (SES) groups manage to enjoy a health advantage for a broad range of conditions regardless of their specific etiology.[7]. This health advantage is believed to extend to the survival of patients diagnosed with most forms of cancer, even though high‐SES individuals may be at higher risk of incidence of cancer at specific sites such as breast and prostate cancer.[8,9]
Survival was poor in this population
Summary
Pancreatic cancer accounts for ~4% of cancer‐related deaths worldwide, and the global burden of pancreatic cancer is increasing.[1]. Methods: Using a population‐based cancer registry in Japan, 3 578 patients with incident pancreatic cancer (1970‐2011) were followed up for 5 years (median follow‐up time 0.42 years). We classified patients into four occupational classes based on their longest‐held jobs: white‐collar (professional and managers), service, blue‐ collar, and those not actively employed. Results: Overall survival was poor in this population (median, 0.50 and 0.33 years in white‐collar and service classes, respectively). Compared with white‐collar patients, survival was significantly poorer across all occupational classes, most pronounced in the service worker group: mortality HRs ranged from 1.11 (95% CI 1.00‐1.24) in blue‐collar workers to 1.24 (95% CI 1.12‐1.37) in service workers. Even in the setting of lethal prognostic cancer with universal health coverage, high‐occupational class groups may enjoy a health advantage
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