Socioeconomic inequality in cancer survival – changes over time. A population-based study, Denmark, 1987–2013

Abstract

Background: Socioeconomic inequality in survival after cancer have been reported in several countries and also in Denmark. Changes in cancer diagnostics and treatment may have changed the gap in survival between affluent and deprived patients and we investigated if the differences in relative survival by income has changed in Danish cancer patients over the past 25 years. Methods: The 1-and 5-year relative survival by income quintile is computed by comparing survival among cancer patients diagnosed 1987-2009 to the survival of a cancer-free matched sample of the background population. The comparison is done within the 15 most common cancers and all cancers combined. The gap in relative survival due to socioeconomic inequality for the period 1987-1991 is compared the period 2005-2009. Results: The relative 5-year survival increased for all 15 cancer sites investigated in the study period. In general, low-income patients diagnosed in 1987-1991 had between 0% and 11% units lower 5-year relative survival compared with high-income patients; however, only four sites (breast, prostate, bladder and head & neck) were statistically different. In patients diagnosed 2005-2009, the gap in 5-year RS was ranging from 2% to 22% units and statistically significantly different for 9 out of 15 sites. The results for 1-year relative survival were similar to the 5-year survival gap. An estimated 22% of all deaths at five years after diagnosis could be avoided had patients in all income groups had same survival as the high-income group. Conclusion: In this nationwide population-based study, we observed that the large improvements in both short-and long-term cancer survival among patients diagnosed 1987-2009. The improvements have been most pronounced for high-income cancer patients, leading to stable or even increasing survival differences between richest and poorest patients. Improving survival among low-income patients would improve survival rates among Danish cancer patients overall and reduce differences in survival when compared to other Western European countries.

Differences in cancer survival by area-level socio-economic disadvantage: A population-based study using cancer registry data

“…A Danish study found differences between low-income and high-income patients in five-year survival for most cancers from 1987 to 2009, and that these had widened in the most recent five years, partly due to greater gains in cancer survival by affluent cases. [31] Similarly, a New Zealand study reported lower survival for low income cancer cases compared with high-income patients; the authors also found that the observed gaps in survival has widened over 13 years. [32] Another study from New Zealand observed socio-economic inequalities in cancer survival, which were only partly explained by extent of disease at diagnosis.…”

Disengaging with the cancerous body

“…In terms of cancer, this is backed by epidemiological evidence, showing that 'multi-morbidity' is more prevalent among people living with cancer than among those who have not had cancer, a tendency that increases with social disadvantage (Hovaldt et al, 2015). In addition, there are significant social differences in how people with diverse social backgrounds manage after being diagnosed with cancer (Dalton et al, 2019;Hovaldt et al, 2015).…”

Stage-specific survival has improved for young breast cancer patients since 2000: but not equally

“…New treatments have also improved the survival of patients with certain tumor subtypes, for example Herceptin has improved the survival of HER2 positive patients [7,8]. Although breast cancer survival has been improving, there is concern that patients with low socioeconomic status (SES) have not gained as much from recent advancements [9][10][11][12][13][14].…”