Department of Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.
PLoS One. 2012;7(8):e44325. doi: 10.1371/journal.pone.0044325. Epub 2012 Aug 30.
This population-based study investigated the relationship between individual and neighborhood socioeconomic status (SES) and mortality rates for major cancers in Taiwan.
A population-based follow-up study was conducted with 20,488 cancer patients diagnosed in 2002. Each patient was traced to death or for 5 years. The individual income-related insurance payment amount was used as a proxy measure of individual SES for patients. Neighborhood SES was defined by income, and neighborhoods were grouped as living in advantaged or disadvantaged areas. The Cox proportional hazards model was used to compare the death-free survival rates between the different SES groups after adjusting for possible confounding and risk factors.
After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score, urbanization, and area of residence), tumor extent, treatment modalities (operation and adjuvant therapy), and hospital characteristics (ownership and teaching level), colorectal cancer, and head and neck cancer patients under 65 years old with low individual SES in disadvantaged neighborhoods conferred a 1.5 to 2-fold higher risk of mortality, compared with patients with high individual SES in advantaged neighborhoods. A cross-level interaction effect was found in lung cancer and breast cancer. Lung cancer and breast cancer patients less than 65 years old with low SES in advantaged neighborhoods carried the highest risk of mortality. Prostate cancer patients aged 65 and above with low SES in disadvantaged neighborhoods incurred the highest risk of mortality. There was no association between SES and mortality for cervical cancer and pancreatic cancer.
Our findings indicate that cancer patients with low individual SES have the highest risk of mortality even under a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.
本基于人群的研究调查了个体和社区社会经济地位（SES）与台湾主要癌症死亡率之间的关系。
对 2002 年诊断的 20488 例癌症患者进行了基于人群的随访研究。每位患者均追踪至死亡或随访 5 年。患者 SES 的个体收入相关保险支付金额用作个体 SES 的替代指标。社区 SES 由收入定义，将社区分为处于有利或不利地位的地区。使用 Cox 比例风险模型，在调整可能的混杂因素和风险因素后，比较不同 SES 组的无死亡生存率。
在调整了患者特征（年龄、性别、Charlson 合并症指数评分、城市化程度和居住区域）、肿瘤程度、治疗方式（手术和辅助治疗）以及医院特征（所有权和教学水平）后，65 岁以下患有结直肠癌和头颈部癌症且 SES 较低的患者在劣势社区中，其死亡率是 SES 较高的优势社区患者的 1.5 至 2 倍。在肺癌和乳腺癌中发现了跨层次交互效应。65 岁以下 SES 较低的肺癌和乳腺癌患者的死亡率最高。65 岁及以上 SES 较低的前列腺癌患者在劣势社区中的死亡率最高。SES 与宫颈癌和胰腺癌的死亡率之间没有关联。
即使在全民健康保险制度下，SES 较低的癌症患者的死亡率也最高。公共卫生策略和福利政策必须继续关注这一弱势群体。
