Socio-economic disparities in long-term cancer survival—10 year follow-up with individual patient data
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Reasons for the social gradient in cancer survival are not fully understood yet. Previous studies were often only able to determine the socio-economic status of the patients from the area they live in, not from their individual socio-economic characteristics.
In a multi-centre cohort study with 1633 cancer patients and 10-year follow-up, individual socio-economic position was measured using the indicators: education, job grade, job type, and equivalence income. The effect on survival was measured for each indicator individually, adjusting for age, gender, and medical characteristics. The mediating effect of health behaviour (alcohol and tobacco consumption) was analysed in separate models.
Patients without vocational training were at increased risk of dying (rate ratio (RR) 1.5, 95% confidence interval (CI) 1.1–2.2) compared to patients with the highest vocational training; patients with blue collar jobs were at increased risk (RR 1.2; 95% CI 1.0–1.5) compared to patients with white collar jobs; income had a gradual effect (RR for the lowest income compared to highest was 2.7, 95% CI 1.9–3.8). Adding health behaviour to the models did not change the effect estimates considerably. There was no evidence for an effect of school education and job grade on cancer survival.
Patients with higher income, better vocational training, and white collar jobs survived longer, regardless of disease stage at baseline and of tobacco and alcohol consumption.
KeywordsSocio-economic position Socio-economic status Cancer Health inequality Health inequity Disparities Income Education Job grade Survival
Compliance with ethical standards
This work was supported by a grant from the German Federal Ministry of Education and Research (grant number 01ZZ0106) to Prof. Reinhold Schwarz for baseline data collection. The mortality follow-up received no funding.
Conflicts of interest
The authors declare that they have no conflict of interest.
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