Socioeconomic differences in cancer survival.

M Kogevinas, M G Marmot, A J Fox, P O Goldblatt

Department of Community Medicine, University College London and Middlesex School of Medicine, United Kingdom.

STUDY OBJECTIVE--The aim was to investigate the relationship between socioeconomic status and cancer survival. DESIGN--This was a prospective study, linking census and vital registration records for an approximate 1% representative sample of those enumerated in England and Wales in the 1971 census. SETTING--The study population is nationwide. PARTICIPANTS--The study sample consists of 250,588 men and 262,484 women. During 1971-81, 17,844 cases of cancer were registered, and of those registered, 13,532 died during 1971-1983. MEASUREMENTS AND MAIN RESULTS--Socioeconomic status was assessed in terms of housing tenure. Council tenants, the low socioeconomic group, had poorer survival than owner occupiers, the high socioeconomic group, for the combined group of all neoplasms, and for 11 out of 13 neoplasms examined in males, and 12 out of 15 neoplasms examined in females. Differences were found irrespective of age, cause of death and prognosis of the cancer. Survival analysis by length of follow up indicated that council tenants were more likely to present at a later stage than owner occupiers. CONCLUSIONS--Wide survival differentials were observed between socioeconomic groups. Differences in survival for cancers of poor prognosis (eg, oesophagus, pancreas, lung) where treatment has little effect, cannot be attributed to socioeconomic differences in treatment. The survival differences for cancers of good prognosis (eg, corpus uteri, bladder, skin) could, in part, be due to differences in treatment. It is probable that delay in seeking care is one of the major contributing causes.

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