J Korean Med Sci.  2017 Dec;32(12):1974-1983. 10.3346/jkms.2017.32.12.1974.

Disparities by Age, Sex, Tumor Stage, Diagnosis Path, and Area-level Socioeconomic Status in Survival Time for Major Cancers: Results from the Busan Cancer Registry

Affiliations
  • 1Department of Statistics, Yeungnam University, Daegu, Korea.
  • 2Department of Preventive Medicine, Pusan National University Hospital, Busan, Korea. kchprev@gmail.com

Abstract

Our goal was to examine the effect of area-level deprivation on patient survival time for seven major cancers "” stomach, colon, liver, lung, breast, cervix, and thyroid cancer. Data on 10,902 subjects who were diagnosed with major cancers from 2010 and 2011 in Busan were collected regarding the survival time along with several important prognostic factors and an area-level deprivation index was constructed from education, income, unemployment, and welfare assistance, to assess the comprehensive area-level socioeconomic status. A multilevel Cox proportional hazard model was used to investigate the effects of multiple risk factors such as gender, age, tumor stage, diagnosis path, and the area-level deprivation. After adjusting for risk factors the area-level deprivation index was found to be significant in associating with higher hazard rate for several cancers. Estimated hazard ratios (95% CI) were 1.08 (0.99-1.18), 1.23 (1.12-1.36), 1.36 (1.21-1.53) for the second, the third, and the fourth quartile of deprivation index groups, respectively, when compared to the least deprived group. When compared with the least deprived group, the more deprived group showed significant decrease in survival time for major cancers. This novel finding may contribute to the literature regarding the association of area-level socioeconomic status and highlight the importance of careful monitoring of socioeconomic characteristics for cancer prevention and care services.

Keyword

Cancer; Survival Time; Area-level Deprivation; Hazard Ratio; Risk Factors

MeSH Terms

Breast
Busan*
Cervix Uteri
Colon
Diagnosis*
Education
Female
Humans
Liver
Lung
Proportional Hazards Models
Risk Factors
Social Class*
Stomach
Thyroid Neoplasms
Unemployment

Figure

  • Fig. 1 Multivariate-adjusted HRs and 95% CIs for cancer-specific survival time from a stratified analysis by tumor stage. HR for one unit change of area-level deprivation as continuous scale was presented. Larger value of area-level deprivation index corresponds to more deprivation. Black circles represent the estimated HR and solid horizontal lines represent the 95% CI. HR = hazard ratio, CI = confidence interval.


Cited by  1 articles

Cancer-free Life Expectancy in Small Administrative Areas in Korea and Its Associations with Regional Health Insurance Premiums
Eunjeong Noh, Hee-Yeon Kang, Jinwook Bahk, Ikhan Kim, Young-Ho Khang
J Korean Med Sci. 2021;36(42):e269.    doi: 10.3346/jkms.2021.36.e269.


Reference

1. Singh GK, Williams SD, Siahpush M, Mulhollen A. Socioeconomic, rural-urban, and racial inequalities in US cancer mortality: part I-all cancers and lung cancer and part II-colorectal, prostate, breast, and cervical cancers. J Cancer Epidemiol. 2011; 2011:107497.
2. Skyrud KD, Bray F, Eriksen MT, Nilssen Y, Møller B. Regional variations in cancer survival: impact of tumour stage, socioeconomic status, comorbidity and type of treatment in Norway. Int J Cancer. 2016; 138:2190–2200.
3. Singh GK, Jemal A. Socioeconomic and racial/ethnic disparities in cancer mortality, incidence, and survival in the United States, 1950–2014: over six decades of changing patterns and widening inequalities. J Environ Public Health. 2017; 2017:2819372.
4. Pappas G, Queen S, Hadden W, Fisher G. The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. N Engl J Med. 1993; 329:103–109.
5. Yoon TH. The relationship between social class distribution and mortality. Korean J Health Policy Adm. 2003; 13:99–114.
6. Choi MH, Cheong KS, Cho BM, Hwang IK, Kim CH, Kim MH, Hwang SS, Lim JH, Yoon TH. Deprivation and mortality at the town level in Busan, Korea: an ecological study. J Prev Med Public Health. 2011; 44:242–248.
7. Van der Heyden JH, Schaap MM, Kunst AE, Esnaola S, Borrell C, Cox B, Leinsalu M, Stirbu I, Kalediene R, Deboosere P, et al. Socioeconomic inequalities in lung cancer mortality in 16 European populations. Lung Cancer. 2009; 63:322–330.
8. Diez Roux AV. Investigating neighborhood and area effects on health. Am J Public Health. 2001; 91:1783–1789.
9. Diez Roux AV. Neighborhoods and health: where are we and were do we go from here? Rev Epidemiol Sante Publique. 2007; 55:13–21.
10. Lochner K, Pamuk E, Makuc D, Kennedy BP, Kawachi I. State-level income inequality and individual mortality risk: a prospective, multilevel study. Am J Public Health. 2001; 91:385–391.
11. Martikainen P, Kauppinen TM, Valkonen T. Effects of the characteristics of neighbourhoods and the characteristics of people on cause specific mortality: a register based follow up study of 252,000 men. J Epidemiol Community Health. 2003; 57:210–217.
12. Winkleby MA, Cubbin C. Influence of individual and neighbourhood socioeconomic status on mortality among black, Mexican-American, and white women and men in the United States. J Epidemiol Community Health. 2003; 57:444–452.
13. Yen IH, Kaplan GA. Neighborhood social environment and risk of death: multilevel evidence from the Alameda County Study. Am J Epidemiol. 1999; 149:898–907.
14. Clegg LX, Reichman ME, Miller BA, Hankey BF, Singh GK, Lin YD, Goodman MT, Lynch CF, Schwartz SM, Chen VW, et al. Impact of socioeconomic status on cancer incidence and stage at diagnosis: selected findings from the surveillance, epidemiology, and end results: National Longitudinal Mortality Study. Cancer Causes Control. 2009; 20:417–435.
15. Seeman TE, McEwen BS. Impact of social environment characteristics on neuroendocrine regulation. Psychosom Med. 1996; 58:459–471.
16. Kuznetsov L, Maier W, Hunger M, Meyer M, Mielck A. Associations between regional socioeconomic deprivation and cancer risk: analysis of population-based Cancer Registry data from Bavaria, Germany. Prev Med. 2011; 53:328–330.
17. Meijer M, Bloomfield K, Engholm G. Neighbourhoods matter too: the association between neighbourhood socioeconomic position, population density and breast, prostate and lung cancer incidence in Denmark between 2004 and 2008. J Epidemiol Community Health. 2013; 67:6–13.
18. Major JM, Doubeni CA, Freedman ND, Park Y, Lian M, Hollenbeck AR, Schatzkin A, Graubard BI, Sinha R. Neighborhood socioeconomic deprivation and mortality: NIH-AARP diet and health study. PLoS One. 2010; 5:e15538.
19. Bentley R, Kavanagh AM, Subramanian SV, Turrell G. Area disadvantage, individual socio-economic position, and premature cancer mortality in Australia 1998 to 2000: a multilevel analysis. Cancer Causes Control. 2008; 19:183–193.
20. Chung JI, Song YM, Choi JS, Kim BM. Trends in avoidable death over 20 years in Korea. J Korean Med Sci. 2008; 23:975–981.
21. Khang YH, Lynch JW, Yun S, Lee SI. Trends in socioeconomic health inequalities in Korea: use of mortality and morbidity measures. J Epidemiol Community Health. 2004; 58:308–314.
22. Song YM, Byeon JJ. Excess mortality from avoidable and non-avoidable causes in men of low socioeconomic status: a prospective study in Korea. J Epidemiol Community Health. 2000; 54:166–172.
23. Pickett KE, Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: a critical review. J Epidemiol Community Health. 2001; 55:111–122.
24. Shin HR, Won YJ, Jung KW, Kong HJ, Yim SH, Lee JK, Noh HI, Lee JK, Pisani P, Park JG, et al. Nationwide cancer incidence in Korea, 1999–2001; first result using the national cancer incidence database. Cancer Res Treat. 2005; 37:325–331.
25. Gomez SL, O'Malley CD, Stroup A, Shema SJ, Satariano WA. Longitudinal, population-based study of racial/ethnic differences in colorectal cancer survival: impact of neighborhood socioeconomic status, treatment and comorbidity. BMC Cancer. 2007; 7:193.
26. Ng E, Wilkins R, Fung MF, Berthelot JM. Cervical cancer mortality by neighbourhood income in urban Canada from 1971 to 1996. CMAJ. 2004; 170:1545–1549.
27. Turrell G, Kavanagh A, Draper G, Subramanian SV. Do places affect the probability of death in Australia? A multilevel study of area-level disadvantage, individual-level socioeconomic position and all-cause mortality, 1998–2000. J Epidemiol Community Health. 2007; 61:13–19.
Full Text Links
  • JKMS
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr