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Socioeconomic gaps over time in colorectal cancer survival in England: flexible parametric survival analysis
  1. Mari Kajiwara Saito1,2,
  2. Manuela Quaresma1,
  3. Helen Fowler3,
  4. Sara Benitez Majano1,
  5. Bernard Rachet1
  1. 1Inequalities in Cancer Outcomes Network, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  2. 2Department of Gastroenterology, IMS Tokyo Katsushika General Hospital, Tokyo, Japan
  3. 3Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Dr Mari Kajiwara Saito, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; mari.kajiwara{at}lshtm.ac.uk

Abstract

Background Despite persistent reports of socioeconomic inequalities in colorectal cancer survival in England, the magnitude of survival differences has not been fully evaluated.

Methods Patients diagnosed with colon cancer (n=68 169) and rectal cancer (n=38 267) in England (diagnosed between January 2010 and March 2013) were analysed as a retrospective cohort study using the National Cancer Registry data linked with other population-based healthcare records. The flexible parametric model incorporating time-varying covariates was used to assess the difference in excess hazard of death and in net survival between the most affluent and the most deprived groups over time.

Results Survival analyses showed a clear pattern by deprivation. Hazard ratio of death was consistently higher in the most deprived group than the least deprived for both colon and rectal cancer, ranging from 1.08 to 1.17 depending on the model. On the net survival scale, the socioeconomic gap between the most and the least deprived groups reached approximately −4% at the maximum (−3.7%, 95% CI −1.6 to −5.7% in men, −3.6%, 95% CI −1.6 to −5.7% in women) in stages III for colon and approximately −2% (−2.3%, 95% CI −0.2 to −4.5% in men, −2.3%, 95% CI −0.2 to −4.3% in women) in stage II for rectal cancer at 3 years from diagnosis, after controlling for age, emergency presentation, receipt of resection and comorbidities. The gap was smaller in other stages and sites. For both cancers, patients with emergency presentation persistently had a higher excess hazard of death than those without emergency presentation.

Conclusion Survival disparities were profound particularly among patients in the stages, which benefit from appropriate and timely treatment. For the patients with emergency presentation, excess hazard of death remained high throughout three years from the diagnosis. Public health measures should be taken to reduce access inequalities to improve survival disparities.

  • healthcare disparities
  • neoplasms by site
  • health inequalities

Data availability statement

Data may be obtained from a third party and are not publicly available. Data were provided by Public Health England (PHE). Our data sharing agreement with PHE clearly stipulates that they cannot be shared with any third party without the prior written consent of PHE.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Data were provided by Public Health England (PHE). Our data sharing agreement with PHE clearly stipulates that they cannot be shared with any third party without the prior written consent of PHE.

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Footnotes

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  • Contributors MKS conceived, designed the study, analysed and wrote the first draft of the manuscript. MQ supervised the analysis, revised the paper. HF and SBM revised the paper. BR supervised the study, revised the paper and approved the final manuscript.

  • Funding MKS is a scholar of the British Council Japan Association (number not applicable). MQ, HF and SBM are funded by the Cancer Research UK (C7923/A29018).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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