Disparities in colorectal cancer between Northern and SouthernSweden – a report from the new RISK North database

Abstract

Background: Geographic cancer health disparities have been reported in Sweden. The disparities are not fully understood, but may be attributed to differences in exposure to risk factors as well as differences in health care, socioeconomics and demography. The aim of this study was to describe the new nationwide population based RISK North database and its potential by analysing health disparities in colorectal cancer between Northern and Southern Sweden. Methods: Cancer-specific data from the National Cancer Quality Registers for colorectal, gastric and oesophageal cancer and brain tumours were linked to several nationwide registers hereby creating a new database-RISK North. To exemplify the potential of RISK North, we analyzed differences in colorectal cancer incidence, mortality and survival in relation to gender, age, cohabitation and education between Northern and Southern Sweden 2007-2013. Results: In colon cancer, the age-adjusted incidence per 100.000 was lower in Northern than Southern Sweden, 35.9 in the North vs. 41.1 in the South (p < .01); mortality rates were 11.0 vs. 12.2 (p < .01). For rectal cancer, incidence rates were 17.6 vs. 19.7 (p < .01) and mortality rates 5.33 vs. 5.89 (p ¼ .07), respectively. The largest difference in incidence was demonstrated for colon cancer among individuals >79 years old (190. vs. 237, i.e., $20%). Survival in colon cancer was higher in Southern Sweden, HR 0.92 (0.87-0.98) adjusted for age, gender, co-habiting, education and m-stage at diagnosis. No difference in survival was seen for rectal cancer. Conclusions: The new RISK North database enabled analysis of cancer disparities between Northern and Southern Sweden. The incidence of colorectal cancer were lower in the North of Sweden whereas colon cancer survival was higher in the South. These differences can be further analysed utilising the RISK North database.

Impact of Socioeconomic Status on Cancer Incidence Risk, Cancer Staging, and Survival of Patients with Colorectal Cancer under Universal Health Insurance Coverage in Taiwan

“…Studies conducted in Sweden, Norway, and the US unanimously demonstrated that patients with colorectal cancer who had lower education levels experienced lower survival outcomes [20,[22][23][24]49]. The current study also found that, in Taiwan, patients with colorectal cancer who had elementary or lower education were significantly likely to die compared to those with junior college, university, or higher education.…”

“…Although the impact of socioeconomic status on the incidence, staging, and survival of colorectal cancer has been well-documented in the literature, research has yet to derive a consistent conclusion regarding the numerous impacts due to international disparities in culture and healthcare systems. Although most studies have corroborated the finding that individuals with lower socioeconomic status are at higher risk of colorectal cancer [7][8][9][10][11], more likely to be diagnosed with late-stage colorectal cancer [8,[12][13][14], and prone to lower survival outcomes [15][16][17][18][19][20][21][22][23][24], numerous studies in countries with universal health insurance coverage have indicated that socioeconomic status has no significant impact on the incidence [25,26] and stage of colorectal cancer at diagnosis [27,28].…”

Travel time to care does not affect survival for patients with colorectal cancer in northern Sweden: A data linkage study from the Risk North database

“…To enable studies on cancer disparities between the Northern Health Care Region and the rest of the country, the database also includes data on patients residing in other Swedish regions. The Risk North project and database has been described in detail earlier [12].…”

“…Recently, we published a study that found lower survival for patients with colon cancer in the Northern Healthcare Region in Sweden, compared with the rest of the country [12]. The Northern Healthcare Region has approximately 900 000 inhabitants living in an area of 224 000 km 2 , resulting in a population density of only 4 pop./km 2 .…”

“…In many areas in Europe and the U.S., the rural population is older and has a lower socioeconomic status compared with urban populations [ 9 , 10 ]. Both older age and low socioeconomic status have been associated with poorer prognosis in colorectal cancer [ 11 , 12 ]. In addition, there may be differences between rural and urban areas in the proportion of persons living alone, a factor that has been shown to adversely affect outcomes in colorectal cancer [ 11 – 13 ].…”