Abstract
Simple SummaryStudies investigating the social gradient in digestive cancer survival are scarce, and the statistical methods used do not always consider important assumptions in survival analysis for adequate assessment. Using an ecological index (European Deprivation Index), we found a negative impact of social environment in digestive cancers net survival (especially for esophagus, stomach, bile ducts among females; colon and rectum for both sexes) and provided insight into how this social gradient in cancer survival builds up, and at what time of follow-up it appears. These results can guide clinical practice/public health actions to address social inequalities in survival by targeting digestive cancers with the greatest impact and identifying key follow-up periods to implement actions.Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006–2009, collected through the French network of cancer registries, were included (end of follow-up 30 June 2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.
Highlights
The role of social environment in health has been established for many years and concerns a wide variety of diseases, both chronic and acute, including digestive pathologies [1]
Concerning the survival of patients with cancer in France, in agreement with the international literature based on either individual or contextual measures of social situation [3,4,5], a previous study showed that the prognosis was worse for the most disadvantaged populations than for the least disadvantaged ones, for most cancer sites, with a marked difference for some digestive ones, such as colorectal cancer and liver cancer in males or bile duct cancer and esophageal cancer in females [6]
They did not account for baseline hazard flexibility and the putative time-dependent and non-linear effect of variables or interaction with age, which could be a limitation in cancer survival analysis [9]
Summary
The role of social environment in health has been established for many years and concerns a wide variety of diseases, both chronic and acute, including digestive pathologies [1]. Concerning the survival of patients with cancer in France, in agreement with the international literature based on either individual or contextual measures of social situation [3,4,5], a previous study showed that the prognosis was worse for the most disadvantaged populations than for the least disadvantaged ones, for most cancer sites, with a marked difference for some digestive ones, such as colorectal cancer and liver cancer in males or bile duct cancer and esophageal cancer in females [6] In this previous study, as in the international literature on that subject, some elements that might help understand this social gradient were not fully explored. The isolation or lack of autonomy of the elderly may make it worse
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
