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Socio-economic disparities in long-term cancer survival—10 year follow-up with individual patient data

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Author information

Authors and Affiliations

  1. Institute of Medical Biostatistics, Epidemiology and Informatics, Division of Epidemiology and Health Services Research, University Medical Centre Mainz, Obere Zahlbacher Straße 69, 55131, Mainz, Germany

    Susanne Singer

  2. University Cancer Centre Mainz, Mainz, Germany

    Susanne Singer

  3. Department of General and Visceral Surgery, Helios Park Clinic, Leipzig, Germany

    Michael Bartels

  4. Department of Gynaecology, University Medical Centre Leipzig, Leipzig, Germany

    Susanne Briest & Jens Einenkel

  5. Department of Medical Oncology, University Medical Centre Leipzig, Leipzig, Germany

    Dietger Niederwieser

  6. Department of Radiation Oncology, University Medical Centre Leipzig, Leipzig, Germany

    Kirsten Papsdorf

  7. Department of Urology, University Medical Centre Leipzig, Leipzig, Germany

    Jens-Uwe Stolzenburg

  8. Department of Social Pedagogy and Adult Education, Faculty of Educational Sciences, Goethe University, Frankfurt, Germany

    Sophie Künstler

  9. Regional Clinical Cancer Registry Leipzig, University Medical Centre Leipzig, Leipzig, Germany

    Sabine Taubenheim

  10. Department of Psychotherapy, Helios Park Clinic, Leipzig, Germany

    Oliver Krauß

Authors
  1. Susanne Singer
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  8. Sophie Künstler
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Corresponding author

Correspondence to Susanne Singer.

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Funding

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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Singer, S., Bartels, M., Briest, S. et al. Socio-economic disparities in long-term cancer survival—10 year follow-up with individual patient data. Support Care Cancer 25, 1391–1399 (2017). https://doi.org/10.1007/s00520-016-3528-0

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  • DOI: https://doi.org/10.1007/s00520-016-3528-0

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