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OP27 Socioeconomic position and mortality from brain tumour – a swedish population-based study
  1. AR Khanolkar1,
  2. M Talbäck2,
  3. R Ljung2
  1. 1GOS Institute of Child Health, University College London, London, UK
  2. 2Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden


Background Socioeconomic disparities in mortality from various cancers are well documented with patients from lower socioeconomic background having an increased risk for mortality. However, similar evidence on differences in mortality from tumours of the central nervous system is both limited and conflicting. We investigated associations between socioeconomic factors (education, income and marital status) and mortality after a brain tumour diagnosis.

Methods The study included all patients diagnosed with a primary brain tumour in Sweden between 1993–2010 as reported to the national cancer register and were followed-up until 31 st December 2015. Data on education, disposable income and marital status were obtained via linkage with national registers. We used flexible parametric models with restricted cubic splines to estimate the excess hazard ratio [EHR] (the analogue of relative survival) by socioeconomic factors for glioma, glioblastoma and meningioma. Models were adjusted for age at diagnosis, tumour location, healthcare region and country of birth, and run separately for men and women.

Results 6075 men and 7831 women developed a brain tumour during the study period. 4197 (69%) men and 3370 (43%) women died by the end of follow-up. Men and women with primary education had increased mortality from glioma (EHR, 1.13, 95% CI 1.04–1.24, and 1.11, 1.00–1.24) and glioblastoma (EHR 1.20, 1.07–1.35 and 1.14, 1.00–1.31 respectively) compared to those with university education. Men in the lowest quartile of income had 29% and 25% higher mortality from glioma and glioblastoma compared to those in the highest income quartile (EHR 1.29, 1.17–1.43 and 1.25, 1.10–1.42 respectively). Women in the lowest quartile of income had higher mortality from meningioma than those in the highest quartile (EHR 3.63, 1.76–7.52). Being single (EHR, 1.15, 1.04–1.26 and 1.21, 1.06–1.38 for men and women respectively) and widowed (EHR, 1.30, 1.08–1.58 and 1.14, 1.00–1.30 for men and women respectively) was associated with increased mortality from glioma. Similarly, being single was associated with increased mortality from meningioma in men (EHR 2.49, 1.42–4.36) and women (EHR 2.10, 1.18–3.73).

Conclusion While lower education and low income are associated with increased mortality from glioma in men, only lower education is associated with increased mortality from glioma in women. Low income was associated with increased mortality from meningioma in women only. Being single or widowed were associated with increased mortality from glioma and meningioma in both sexes. These disparities were observed despite access to a universal healthcare system. Earlier detection in individuals from higher socioeconomic groups could be a potential explanation.

  • Brain tumour
  • mortality
  • health inequalities

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