The effect of socioeconomic status on health-care delay and treatment of esophageal cancer

Abstract

BackgroundSocioeconomic status (SES) has been focused on as a key determinant of the incidence of cancer, cancer stage at diagnosis as well as treatment choices in western countries. However, to the authors’ knowledge, little work has been done concerning the relationship of SES and esophageal cancer in China.MethodsPatients diagnosed with primary esophageal cancer from January to December 2007 in Qilu hospital were included. Socioeconomic status was determined by a questionnaire including religion, years of schooling and high education, place of residence, occupation, annual household income, and insurance.ResultsA total of 238 cases were collected in this study. Linear-by-linear association testing revealed that health-care delay was significantly associated with SES (P = 0.009). Multivariable logistic regression analysis revealed that increased health-care delay (>2 months) was more frequently observed in patients with lower SES (OR 2.271; 95% CI 1.069–4.853). Patients diagnosed at TNM I and II were more frequently in higher SES groups (P = 0.017). The association test was statistically significant for undergoing surgical resection only (P = 0.015) and chemotherapy (P = 0.015). Multivariable logistic regression analysis revealed that surgical resection only was less performed in higher SES group compared with lower SES group (OR 0.372; 95% CI 0.188–0.734). For chemotherapy, higher SES patients had a three-fold higher likelihood compared with lower SES group (OR 3.042; 95% CI 1.335–6.928).ConclusionSocioeconomic status was found to be associated with health-care delay, tumor stage and treatment modalities in esophageal cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-015-0579-9) contains supplementary material, which is available to authorized users.

Patterns of Care and Treatment Outcomes of Elderly Patients with Stage I Esophageal Cancer: Analysis of the National Cancer Data Base

“…sociodemographic differences may prevent a patient from being managed surgically. 4,5 Patients with clinically staged T1-2N0 EC comprise a substantially heterogeneous population that has been highly underrepresented or excluded from many phase III trials of trimodality therapy. As such, there are several recommended options for these patients, including esophagectomy (Eso), chemoradiotherapy (CRT), and various surgical techniques of local excision (LE).…”

Characteristics of long‐term survivors with multiple myeloma: A National Cancer Data Base analysis

“…20 The poor financial affordability could dramatically prevent patients from receiving optimal treatments. In addition, patients with lower socioeconomic status 23,24 and a lower educational level 25 were more likely to delay office visits and had tumors of higher stages at the time of diagnosis. Malnutrition in impoverished patients also could make the adverse effects of myeloma treatment intolerable and prevent physicians from prescribing aggressive therapy, 26 a situation that also was observed in patients with complicated comorbidities.…”

The incidence and mortality of esophageal cancer and its relationship with development in the world

“…Studies have shown that in countries with medium HDI, EC is one of the most common cancers . Indeed, EC is more common in less developed or developing countries due to smoking, alcohol consumption, nutritional status, environmental pollution and life style behavior (Keramatinia et al, 2016;Koca et al, 2015;Liu et al, 2014;Napier et al, 2014;Wang et al, 2015) -combine. HDI is moderate or low in areas with high rates of EC.…”

“…For unknown reasons, the incidence of SCC has declined in recent years while the incidence of ADC has increased (Kim et al, 2014). EC is one of the cancers that are strongly associated with social and economic status (Dar et al, 2013;Wang et al, 2015). Studies have shown that tobacco, weak nutrition and alcohol are most associated with EC, especially the SCC type (Lin et al, 2013;Liu et al, 2014;Salehi et al, 2013).…”