Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Ontario, Canada.
Cancer. 2010 Sep 1;116(17):4160-7. doi: 10.1002/cncr.25427.
Lower socioeconomic status (SES) is associated with worsened cancer survival. The authors evaluate the impact of SES on stage of cancer at diagnosis and survival in Ontario, Canada.
All incident cases of breast, colon, rectal, nonsmall cell lung, cervical, and laryngeal cancer diagnosed in Ontario during the years 2003-2007 were identified by using the Ontario Cancer Registry. Stage information is captured routinely for patients seen at Ontario's 8 Regional Cancer Centers (RCCs). The Ontario population was divided into quintiles (Q1-Q5) based on community median household income reported in the 2001 census; Q1 represents the poorest communities. Overall survival (OS) and cancer-specific survival (CSS) were determined with Kaplan-Meier methodology. A Cox model was used to evaluate the association between survival and SES, stage, and age.
Stage at diagnosis was available for 38,431 of 44,802 (85%) of cases seen at RCCs. The authors observed only very small differences in stage distribution by SES. Across all cases in Ontario, the authors found substantial gradients in 5-year OS and 3-year CSS across Q1 and Q5 for breast (7% absolute difference in OS, P < .001; 4% CSS, P < .001), colon (8% OS, P < .001; 3% CSS, P = .002), rectal (9% OS, P < .001; 4% CSS, P = .096), nonsmall cell lung (3% OS, P = .002; 2% CSS, P = .317), cervical (16% OS, P < .001; 10% CSS, P = .118), and laryngeal cancers (1% OS, P = .045; 3% CSS, P = .011). Adjustments for stage and age slightly diminished the survival gradient only among patients with breast cancer.
Despite universal healthcare, SES remains associated with survival among patients with cancer in Ontario, Canada. Disparities in outcome were not explained by differences in stage of cancer at time of diagnosis.
较低的社会经济地位（SES）与癌症预后恶化有关。作者评估 SES 对加拿大安大略省癌症诊断时的分期和生存的影响。
通过使用安大略癌症登记处，确定了 2003-2007 年期间在安大略省诊断出的乳腺癌、结肠癌、直肠癌、非小细胞肺癌、宫颈癌和喉癌的所有病例。为在安大略省 8 个地区癌症中心（RCC）就诊的患者常规采集分期信息。根据 2001 年人口普查报告的社区家庭中位数收入，将安大略省人口分为五等分（Q1-Q5）；Q1 代表最贫困的社区。通过 Kaplan-Meier 方法确定总生存率（OS）和癌症特异性生存率（CSS）。使用 Cox 模型评估生存与 SES、分期和年龄之间的关系。
在 RCC 就诊的 44802 例病例中，有 38431 例（85%）获得了诊断时的分期。作者仅观察到 SES 对分期分布的影响非常小。在安大略省的所有病例中，作者发现 OS 和 CSS 的 5 年和 3 年生存率在 Q1 和 Q5 之间存在显著差异，乳腺癌为 7%（OS 差异绝对值，P <.001；CSS，P <.001），结肠癌为 8%（OS，P <.001；CSS，P =.002），直肠癌为 9%（OS，P <.001；CSS，P =.096），非小细胞肺癌为 3%（OS，P =.002；CSS，P =.317），宫颈癌为 16%（OS，P <.001；CSS，P =.118），喉癌为 1%（OS，P =.045；CSS，P =.011）。对分期和年龄进行调整后，仅在乳腺癌患者中，生存梯度略有减小。
尽管有全民医疗保健，SES 仍然与加拿大安大略省癌症患者的生存有关。结果的差异不能用诊断时癌症分期的差异来解释。
