Adam Martin, Rueegg Corina S, Schmidlin Kurt, Spoerri Adrian, Niggli Felix, Grotzer Michael, von der Weid Nicolas X, Egger Matthias, Probst-Hensch Nicole, Zwahlen Marcel, Kuehni Claudia E
Swiss Tropical and Public Health Institute, 4002, Basel, Switzerland.
University of Basel, 4001, Basel, Switzerland.
Int J Cancer. 2016 Jun 15;138(12):2856-66. doi: 10.1002/ijc.30029. Epub 2016 Mar 1.
In this study, we investigated whether childhood cancer survival in Switzerland is influenced by socioeconomic status (SES), and if disparities vary by type of cancer and definition of SES (parental education, living condition, area-based SES). Using Cox proportional hazards models, we analyzed 5-year cumulative mortality in all patients registered in the Swiss Childhood Cancer Registry diagnosed 1991-2006 below 16 years. Information on SES was extracted from the Swiss census by probabilistic record linkage. The study included 1602 children (33% with leukemia, 20% with lymphoma, 22% with central nervous system (CNS) tumors); with an overall 5-year survival of 77% (95%CI 75-79%). Higher SES, particularly parents' education, was associated with a lower 5-year cumulative mortality. Results varied by type of cancer with no association for leukemia and particularly strong effects for CNS tumor patients, where mortality hazard ratios for the different SES indicators, comparing the highest with the lowest group, ranged from 0.48 (95%CI: 0.28-0.81) to 0.71 (95%CI: 0.44-1.15). We conclude that even in Switzerland with a high quality health care system and mandatory health insurance, socioeconomic differences in childhood cancer survival persist. Factors causing these survival differences have to be further explored, to facilitate universal access to optimal treatment and finally eliminate social inequalities in childhood cancer survival.
在本研究中，我们调查了瑞士儿童癌症生存率是否受到社会经济地位（SES）的影响，以及差异是否因癌症类型和SES定义（父母教育程度、生活条件、基于地区的SES）而异。我们使用Cox比例风险模型，分析了瑞士儿童癌症登记处登记的1991年至2006年诊断的16岁以下所有患者的5年累积死亡率。SES信息通过概率记录链接从瑞士人口普查中提取。该研究纳入了1602名儿童（33%患有白血病，20%患有淋巴瘤，22%患有中枢神经系统（CNS）肿瘤）；总体5年生存率为77%（95%CI 75 - 79%）。较高的SES，尤其是父母的教育程度，与较低的5年累积死亡率相关。结果因癌症类型而异，白血病无关联，而对于CNS肿瘤患者影响尤为显著，不同SES指标的死亡风险比（最高组与最低组比较）范围为0.48（95%CI：0.28 - 0.81）至0.71（95%CI：0.44 - 1.15）。我们得出结论，即使在拥有高质量医疗保健系统和强制性医疗保险的瑞士，儿童癌症生存方面的社会经济差异依然存在。必须进一步探索导致这些生存差异的因素，以促进普遍获得最佳治疗，并最终消除儿童癌症生存方面的社会不平等。
