Abstract
BackgroundWe hypothesized that lower socioeconomic status (SES) was associated with higher all‐cause mortality in patients newly diagnosed with cancer, particularly in the elderly population.MethodsWe collected study patients from the stratified random sample of Korean National Health Insurance Elderly Cohort (2002‐2015). The Cox's proportional hazards model was used to investigate the risk factors for mortality. Income level and composite deprivation index (CDI) 2010 were used to define the SES: low, intermediate, and high SES groups. The comorbidities were measured using Charlson Comorbidity Index score. After a wash‐out period (2002), the final study population was 108 626 (2003‐2015).ResultsIn multivariate analysis, low SES was associated with poor overall survival (OS) (HR = 1.08, 95% CI: 1.05‐1.12, P < 0.001) and cancer‐specific survival (CSS) (HR = 1.11, 95% CI: 1.06‐1.16, P < 0.001) particularly for patients aged 70‐79 years. High SES was favorable prognostic factor of OS in patients aged 60‐69 years (HR = 0.85, 95% CI: 0.81‐0.89, P < 0.001), 70‐79 years (HR = 0.90, 95% CI: 0.87‐0.93, P < 0.001), and ≥80 years (HR = 0.91, 95% CI: 0.87‐0.96, P < 0.001). However, SES was not associated with CSS in advanced age patients (≥80 years). Patients with low SES manifesting colorectal, urinary, liver, gastric, melanoma, and esophageal cancers demonstrated worse OS, compared to patients with intermediate SES. Also, low SES patients with urinary, liver, or colorectal cancers or melanoma demonstrated worse CSS compared to those with intermediate SES.ConclusionLow SES at the time of cancer diagnosis is associated with increased risk of OS and CSS in elderly patients. Depending on cancer sites, different patterns of OS and CSS were observed according to SES. Further elucidation of the causes underlying these phenomena is needed along with appropriate support for elderly cancer patients with low SES.
Highlights
Cancer is one of the public health concerns in Korea due to its status as the leading cause of death in Korea
The current study revealed that socioeconomic status (SES) as defined by household income and degree of regional deprivation was a significant
It is noteworthy that patients with high SES living in an advantageous region and earning high income showed better overall survival (OS), regardless of age, and better cancer‐specific survival (CSS), except in participants ≥80 years old, compared with patients with low SES
Summary
Cancer is one of the public health concerns in Korea due to its status as the leading cause of death in Korea. A growing body of evidence suggests that patients' socioeconomic status (SES) plays an independent role in oncologic outcomes[3] in addition to cancer biology. It is well established that SES based on individual income level has been linked to cancer mortality.[4] neighborhood poverty or regional deprivation has been considered as an important component of SES affecting the outcomes in non‐small cell lung,[5] esophageal,[6] anal cancer.[7] Income level and regional deprivation has often been separately investigated, but the impact of both combined is still lacking. Managing elderly patients with cancer is an important issue in oncology when considering treatment decisions. The current study highlights the impact of SES determined by household income level and regional deprivation to clinical outcomes in elderly patients with cancer using data derived from a national database
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