Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study.
colorectal cancer
epidemiological methods
multilevel
population-based epidemiology
socioeconomic inequalities
survival
Journal
Clinical epidemiology
ISSN: 1179-1349
Titre abrégé: Clin Epidemiol
Pays: New Zealand
ID NLM: 101531700
Informations de publication
Date de publication:
2020
2020
Historique:
received:
05
05
2020
accepted:
25
06
2020
entrez:
18
8
2020
pubmed:
18
8
2020
medline:
18
8
2020
Statut:
epublish
Résumé
Colorectal cancer (CRC) is the most frequently diagnosed cancer in Spain. Socioeconomic inequalities in cancer survival are not documented in Spain. We aim to study the association of socioeconomic inequalities with overall mortality and survival among CRC patients in southern Spain. We conducted a multilevel population-based cohort study, including CRC cases for the period 2011-2013. The study time-to-event outcome was death, and the primary exposure was CRC patients' socioeconomic status assessed by the Spanish deprivation index at the census tract level. We used a mixed-effects flexible hazard model, including census tract as a random intercept, to derive overall survival estimates by deprivation. Among 3589 CRC patients and 12,148 person-years at risk (pyr), 964 patients died before the end of the follow-up. Mortality by deprivation showed the highest mortality rate for the most deprived group (96.2 per 1000 pyr, 95% CI: 84.0-110.2). After adjusting for sex, age, cancer stage, and the area of residence, the most deprived had a 60% higher excess mortality risk than the less deprived group (excess mortality risk ratio: 1.6, 95% CI: 1.1-2.3). We found a consistent association between deprivation and CRC excess mortality and survival. The reasons behind these inequalities need further investigation in order to improve equality cancer outcomes in all social groups.
Sections du résumé
BACKGROUND
BACKGROUND
Colorectal cancer (CRC) is the most frequently diagnosed cancer in Spain. Socioeconomic inequalities in cancer survival are not documented in Spain. We aim to study the association of socioeconomic inequalities with overall mortality and survival among CRC patients in southern Spain.
METHODS
METHODS
We conducted a multilevel population-based cohort study, including CRC cases for the period 2011-2013. The study time-to-event outcome was death, and the primary exposure was CRC patients' socioeconomic status assessed by the Spanish deprivation index at the census tract level. We used a mixed-effects flexible hazard model, including census tract as a random intercept, to derive overall survival estimates by deprivation.
RESULTS
RESULTS
Among 3589 CRC patients and 12,148 person-years at risk (pyr), 964 patients died before the end of the follow-up. Mortality by deprivation showed the highest mortality rate for the most deprived group (96.2 per 1000 pyr, 95% CI: 84.0-110.2). After adjusting for sex, age, cancer stage, and the area of residence, the most deprived had a 60% higher excess mortality risk than the less deprived group (excess mortality risk ratio: 1.6, 95% CI: 1.1-2.3).
CONCLUSIONS
CONCLUSIONS
We found a consistent association between deprivation and CRC excess mortality and survival. The reasons behind these inequalities need further investigation in order to improve equality cancer outcomes in all social groups.
Identifiants
pubmed: 32801917
doi: 10.2147/CLEP.S261355
pii: 261355
pmc: PMC7383045
doi:
Types de publication
Journal Article
Langues
eng
Pagination
797-806Informations de copyright
© 2020 Luque-Fernandez et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
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