Abstract
BackgroundMany factors contribute to socioeconomic status (SES), yet in most survival studies only income is used as a measure for determining SES. We used a complex, composite, census-based metric for socioeconomic deprivation to better distinguish individuals with lower SES and assess its impact on survival and staging trends of oral cancers.MethodsOropharyngeal (OPC) and oral cavity cancer (OCC) cases were identified from the British Columbia cancer registry between 1981–2009 and placed into affluent and deprived neighborhoods using postal codes linked to VANDIX (a composite SES index based on 7 census variables encompassing income, housing, family structure, education, and employment). Stage and cancer-specific survival rates were examined by sex, SES, and time period.ResultsApproximately 50 % of OPC and OCC cases of both sexes resided in SES deprived neighborhoods. Numbers of cases have increased in recent years for all but OCC in men. The deprivation gap in survival between affluent and deprived neighborhoods widened in recent years for OPC and OCC in men, while decreasing for OPC and increasing slightly for OCC in women. Greater proportions of OCC cases were diagnosed at later stage disease for both sexes residing in deprived neighborhoods, a trend not seen for OPC.ConclusionSES remains a significant independent determinant of survival for both OPC and OCC when using a composite metric for SES. OPC survival rates among men have improved, albeit at slower rates in deprived communities. OCC screening programs need to be targeted towards SES-deprived neighborhoods where greater proportions of cases were diagnosed at a later stage and survival rates have significantly worsened in both sexes.
Highlights
Many factors contribute to socioeconomic status (SES), yet in most survival studies only income is used as a measure for determining SES
Study population Cases were identified from the population-based British Columbia Cancer Registry (BCCR) from 1981 to 2009, with selection based on a histological diagnosis of invasive squamous cell carcinoma in the oropharynx and oral cavity, as defined by the International Classifications of Diseases in Oncology, 3rd edition (ICDO-3)
Half of oropharyngeal cancers (OPC) and oral cavity cancers (OCC) cases were found in deprived neighbourhoods, among both men and women
Summary
Many factors contribute to socioeconomic status (SES), yet in most survival studies only income is used as a measure for determining SES. The epidemiology of oral cancers is changing rapidly, especially in high-resource countries, a change associated with declining rates of smoking and increasing prevalence of human papilloma viral infections (HPV) [12]. OPC, which include the tonsils, base of tongue and other oropharyngeal sites, are strongly associated with HPV infection and have shown both an increase in incidence and improved survival over the last several decades. OCC have tended to decline in incidence in high-resource countries [16], change in survival has been variable [17]. With increasing economic disparities in many countries including Canada [18, 19] and changing epidemiology of HNC, it’s important to identify the high-risk populations for developing these cancers using improved and better SES measures
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