Social inequalities in cancer survival

Abstract

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in EconStor may ABSTRACTSocial differentials in survival from 12 common types of cancer were assessed by estimating a mixed additive-multiplicative hazard model on the basis of individual register and census data for the whole Norwegian population. The excess all-cause mortality among cancer patients compared with similar persons without a cancer diagnosis was significantly related to education, occupation and income. It was, on the whole, about 15% lower for men or women who had completed a post-secondary education than for those with only compulsory schooling, taking age, period and registered differences in tumor characteristics and stage at the time of diagnosis into account. The data do not provide clear indications of whether differences in host factors, such as co-morbities and immune functions, or differences in treatment and care are primarily responsible for these inequalities in cancer survival. 3The persistently wide gaps in life expectancy between rich and relatively poor citizens in the industrialized world, even within the supposedly egalitarian Nordic countries, are well documented (e.g., Marmot 1995;Valkonen 1989;Vågerö and Lundberg 1995). Although affluence certainly also takes its toll, it is the material deprivation and various kinds of behaviour prevalent in the lower social classes that -in addition to being important concerns themselvesare the most severe threats to a long and healthy life. This situation can be hard to accept from a human rights perspective where equal opportunities in a wide sense is a key ingredient. A reduction of the social differentials in mortality has therefore also been proclaimed by the European region of the World Health Organization (WHO 1985) as one of the major health challenges. Appropriate interventions require, of course, an accurate description of these differentials, as well as a more profound knowledge of their determinants.In industrialized countries, cardiovascular disease and cancer are now the dominant causes of death, with the former being more than twice as common as the latter. Death rates from cardiovascular diseases have declined in Norway over the last few decades for both sexes, because of both prevention and treatment. Total cancer mortality (i.e., death rates from all types of cancer pooled) for men was on the upturn during the 1970s and 1980s, however.The incidence has, with few exceptions (e.g., stomach cancer), increased considerably, while there have been...

The impact of cancer on spouses' labor earnings

“…The latter is positively linked to income, the chance of surviving cancer, and the incidence of breast and prostate cancer and some other malignancies, whereas it is negatively linked to the incidence of, for example, cervical and lung cancer. 6,19,20 However, other potential confounders are unobserved, and to account for those of them that are time invariant (ie, constant individual-level characteristics potentially affecting earnings, cancer incidence, and survival), a difference-in-differences approach was used.…”

Is mortality after childhood cancer dependent on social or economic resources of parents? A population‐based study

“…No earlier Norwegian study has addressed the possibility of sociodemographic variations in childhood cancer survival, but such variations in adult cancer survival have been documented. [14][15][16] There is also limited knowledge about the importance of socioeconomic resources of parents from other countries, where effects also may be expected to be dissimilar because of inherent differences in the health care and welfare systems. One study from New Zealand showed that cancer survival was significantly reduced if a parent did not have a registered occupation or if a parent was unemployed, and an adverse effect of low education was also weakly indicated, while single parenthood had no impact.…”

The relation between socioeconomic and demographic factors and tumour stage in women diagnosed with breast cancer in Denmark, 1983–1999

“…These factors were significant only for postmenopausal women, although similar patterns were observed among the premenopausal women, suggesting a subgroup of aggressive premenopausal breast cancers less influenced by socioeconomic factors. British Journal of Cancer (2006) Although affluent women have a higher incidence of breast cancer than socially deprived women, several studies using individual or area-based socioeconomic measures have shown that deprived women with breast cancer have poorer survival from disease (Carnon et al, 1994; Stavraky et al, 1996;Kravdal, 2000;Bradley et al, 2001;Thomson et al, 2001;Menvielle et al, 2005;Woods et al, 2005).…”

“…These factors were significant only for postmenopausal women, although similar patterns were observed among the premenopausal women, suggesting a subgroup of aggressive premenopausal breast cancers less influenced by socioeconomic factors. British Journal of Cancer (2006) Although affluent women have a higher incidence of breast cancer than socially deprived women, several studies using individual or area-based socioeconomic measures have shown that deprived women with breast cancer have poorer survival from disease (Carnon et al, 1994; Stavraky et al, 1996;Kravdal, 2000;Bradley et al, 2001;Thomson et al, 2001;Menvielle et al, 2005;Woods et al, 2005).Long-term prognosis of breast cancer patients strongly depends on stage of disease at the time of diagnosis and thus, social inequalities in tumour progression at the time of diagnosis which has been reported in several (Schrijvers et al, 1995;Catalano and Satariano, 1998 Further, a higher proportion of oestrogen receptor positive tumours among women with a higher socioeconomic position has been reported (Gordon, 1995;Twelves et al, 1998;Thomson et al, 2001); this could either be interpreted as a difference in time of diagnosis (Hellman, 1994;Zhu et al, 1997) or as a different distribution of high-risk and low-risk breast cancer types (Anderson et al, 2005) across socioeconomic groups.We investigated the relation between socioeconomic position and tumour progression as measured by high-risk vs low-risk breast cancers at the time of diagnosis, stratified by menopausal status in a large nation-wide population based cohort of 28 765 women diagnosed with breast cancer in Denmark between 1983 and 1999. …”