Socioeconomic variation in cancer survival in the Southeastern Netherlands, 1980-1989

Abstract

The survival rates of patients with cancer by socioeconomic status (SES) has never been investigated in the Netherlands, a country characterized by good general access to health care services. The association between socioeconomic status and survival from cancer of the lung (n = 4591), breast (n = 3928), colorectum (n = 3558), prostate (n = 1484), and stomach (n = 1455) was studied, and the impact of some prognostic factors (stage at diagnosis, histologic type, and treatment) on this association was assessed. Subjects were patients who were diagnosed from 1980 to 1989 and included in the population-based Eindhoven Cancer Registry in the Southeastern Netherlands. The patients were classified by socioeconomic status based on their postal code of residence at the time of diagnosis (3 or 5 categories). The follow-up ended July 1, 1991, at which time relative survival rates and hazard ratios were calculated. A more favorable relative survival for patients living in high SES areas was found for those with cancer of the lung, breast, colorectum, and prostate, whereas for those with stomach cancer, lower survival was found for patients living in high SES areas. For cancer of the lung, colorectum, and prostate, the socioeconomic variation in survival could not be explained by the distribution of the prognostic factors stage, histologic type, and treatment. For patients with breast and stomach cancer, the socioeconomic variation in survival could be ascribed mainly to differences in the percentage of patients diagnosed with a metastasis. Socioeconomic variation in survival from a number of common cancer sites exists in the Netherlands, despite the fairly equal access to health care services for different socioeconomic groups. Most of the variation could not be explained by the differential distribution of stage, histologic type, and treatment across SES categories.