Kelsall Helen L, Baglietto Laura, Muller David, Haydon Andrew M, English Dallas R, Giles Graham G
The Cancer Council Victoria, Carlton, Victoria 3053, Australia.
Soc Sci Med. 2009 Jan;68(2):290-7. doi: 10.1016/j.socscimed.2008.09.070. Epub 2008 Nov 19.
Previous research relating lower socioeconomic status (SES) with poorer survival from colorectal cancer has varied in adjustment for confounding factors and in the use of individual-level or aggregate-level indicators of SES. We investigated the effect of SES and country of birth on survival from colorectal cancers diagnosed in participants of the Melbourne Collaborative Cohort Study. A total of 526 colorectal cancer cases diagnosed since baseline were followed from diagnosis to 1 June 2006 or death. Information on tumour site and stage, and treatments given were obtained from systematic medical record review. SES at diagnosis was assigned using both an area-based measure of social disadvantage and individual level of educational attainment. Cox regression models were used to estimate hazard ratios associated with socioeconomic disadvantage, educational attainment, and country of birth. During an average follow-up of 5.6 years from diagnosis, 230 deaths occurred, 197 from colorectal cancer. After adjusting for age, sex, tumour stage, waist circumference and adjuvant chemotherapy and radiotherapy, the hazard ratios of dying from all causes and from colorectal cancer associated with living in the least disadvantaged areas compared with most disadvantaged areas were 0.73 (95% CI 0.53-1.00, p for trend=0.06) and 0.80 (95% CI 0.57-1.12, p for trend=0.22) respectively. Further adjustment for hospital case-load, tumour characteristics, and lifestyle factors did not change the estimates materially. Level of educational attainment and country of birth were not independent predictors of the risk of dying from colorectal cancer. Despite a universal health care system in Australia, socioeconomic inequalities in survival from colorectal cancer exist, and an enduring challenge is to ensure that improvements in colorectal cancer survival are shared equally across the population.
先前关于较低社会经济地位（SES）与结直肠癌患者较差生存率之间关系的研究，在混杂因素的调整以及SES个体层面或总体层面指标的使用上存在差异。我们调查了SES和出生国对墨尔本协作队列研究参与者中诊断出的结直肠癌生存率的影响。自基线以来诊断出的526例结直肠癌病例从诊断开始随访至2006年6月1日或死亡。通过系统的病历审查获取肿瘤部位、分期及所接受治疗的信息。诊断时的SES通过基于地区的社会劣势衡量指标和个体教育程度来确定。使用Cox回归模型估计与社会经济劣势、教育程度和出生国相关的风险比。从诊断开始平均随访5.6年期间，发生了230例死亡，其中197例死于结直肠癌。在调整年龄、性别、肿瘤分期、腰围以及辅助化疗和放疗后，与生活在最不利地区相比，生活在最有利地区的全因死亡和结直肠癌死亡的风险比分别为0.73（95%CI 0.53 - 1.00，趋势p值 = 0.06）和0.80（95%CI 0.57 - 1.12，趋势p值 = 0.22）。进一步调整医院病例量、肿瘤特征和生活方式因素并未实质性改变估计值。教育程度和出生国并非结直肠癌死亡风险的独立预测因素。尽管澳大利亚有全民医疗保健系统，但结直肠癌生存方面的社会经济不平等依然存在，而一项持久的挑战是确保结直肠癌生存率的改善在全体人群中平等共享。
