The impact of interventions addressing socioeconomic inequalities in cancer-related outcomes in high-income countries: A systematic review.

Abstract

Background: High cancer mortality is a major source of burden. Population-wide programs have been developed to improve cancer outcomes, and although effective in improving outcomes overall, the socioeconomically disadvantaged population have disproportionately benefited. This systematic review evaluated interventions aimed at addressing inequalities in cancer-related outcomes between low and high socioeconomic groups within high-income countries.Materials and Methods: The Cochrane Register of Controlled Trials, EMBASE, and PubMed searches were completed in October 2018. Data extraction and quality appraisal were guided by established mechanisms. Impact of interventions, using odds ratios, with respective 95% confidence intervals were presented, where available.Results: Sixteen studies reporting on 19 interventions were included. Seven interventions (37%) reduced socioeconomic inequalities in cancer-related outcomes, focusing on participation in cancer screening. Interventions included pre-formulated implementation intentions; GP-endorsed screening invitations; enhanced reminder letters; text message reminders; and implementation of an organised screening program.Conclusions: This systematic review found limited evidence on the efficacy of existing interventions that aimed to reduce inequalities in cancer-related outcomes between people living in low and high socioeconomic areas among high-income countries. Future interventions should consider the specific needs of people living in socioeconomically disadvantaged areas to improve the efficacy of an intervention.Significance for public healthAustralia’s health system and public health programs have facilitated improvements in cancer outcomes over time. Disadvantaged populations have lower engagement with services and participation in programs, reflective in their worse outcomes and driving disparity between low and high socioeconomic groups. This is a trend in Australia and internationally. The study evaluated interventions aimed at reducing socioeconomic inequalities in cancer-related outcomes within highincome countries. All effective interventions focused on cancer screening participation and reported improvements, decreasing the risk of dying from screen-detected cancer. Lower uptake remained for low socioeconomic groups. The review demonstrated that interventions must be designed to meet the health literacy needs of the population and that they need to be engaged throughout the developmental phase for uptake to improve. Understanding the characteristics of successful and unsuccessful interventions is the first step in ensuring scalability, and therefore, is of public health importance to acknowledge well-planned interventions that have utilised resources effectively.