Why are socioeconomic inequalities in receipt of treatment found for lung cancer?

Abstract

177 ISSN 1758-1966 10.2217/LMT.13.12 © 2013 Future Medicine Ltd Lung Cancer Manage. (2013) 2(3), 177–180 Intervention-generated inequalities We would hope that interventions to improve health would also reduce health inequalities, but this is not always the case [1]. Evidence is accumulating that effective treatments for lung cancer are not equally received by individuals across the socioeconomic spectrum [2]. Intervention-generated inequalities (IGIs) have been described as “unintended (and unwanted) variations in outcomes, across population subgroups, that result from any element of any health intervention” [3], where, although overall population health may improve as the result of an intervention, differences in access to the intervention, differential uptake, delays in uptake and differential compliance with, or differences in effectiveness of, an intervention may result in inequalities in outcome [3,4]. The IGI framework expands on previous equity hypotheses that have attempted to describe variations in the provision and uptake of interventions. The ‘inverse care law’ states that “the availability of good quality healthcare is inversely related to need in the population served” [5]. The ‘inverse prevention law’ suggests that a similar socioeconomic gradient also exists in health prevention [6], and the ‘inverse equity hypothesis’ proposed that public health interventions initially widen socioeconomic inequalities due to preferential uptake by more advantaged groups before the less advantaged follow suit, eventually improving health overall [7]. However, none of the above equity laws/hypotheses consider how interventions can be designed to reduce inequality. In order to expand these equity laws into an evidence-based framework and model of intervention inequality, it is necessary to examine all the possible stages where inequalities may be introduced and consider ways in which these can be addressed, as it is likely that IGIs contribute to overall socioeconomic inequalities in morbidity and mortality [3].