Singer Susanne, Roick Julia, Briest Susanne, Stark Sylvia, Gockel Ines, Boehm Andreas, Papsdorf Kirsten, Meixensberger Jürgen, Müller Tobias, Prietzel Torsten, Schiefke Franziska, Dietel Anja, Bräunlich Jens, Danker Helge
Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Mainz, Germany.
University Cancer Centre, Mainz, Germany.
Int J Cancer. 2016 Oct 15;139(8):1696-702. doi: 10.1002/ijc.30212. Epub 2016 Jun 11.
We explored the relationship between socio-economic characteristics and cancer stage at presentation. Patients admitted to a university hospital for diagnosis and treatment of cancer provided data on their education, vocational training, income, employment, job, health insurance and postcode. Tumor stage was classified according to the Union International Contre le Cancer (UICC). To analyze disparities in the likelihood of late-stage (UICC III/IV vs. I/II) diagnoses, logistic regression models adjusting for age and gender were used. Out of 1,012 patients, 572 (59%) had late-stage cancer. Separately tested, increased odds of advanced disease were associated with post-compulsory education compared to college degrees, with apprenticeship and no vocational training, with unemployment, disability pension, jobs with a low hierarchy level, blue collar jobs and with low income. Health insurance and community size were not related with late-stage cancer. Jointly modelled, there was evidence for an independent effect of unemployment (odds ratio (OR) 1.7, CI 1.0-2.8), disability pension (OR 1.8, CI 1.0-3.2) and very low income (OR 2.6, CI 1.1-6.1) on the likelihood of advanced disease stage. It is of great concern that these socio-economic gradients occur even in systems with equal access to health care.
我们探究了社会经济特征与就诊时癌症分期之间的关系。因癌症诊断和治疗而入住大学医院的患者提供了有关其教育程度、职业培训、收入、就业、工作、医疗保险和邮政编码的数据。肿瘤分期根据国际抗癌联盟(UICC)进行分类。为了分析晚期(UICC III/IV期与I/II期)诊断可能性的差异,我们使用了对年龄和性别进行调整的逻辑回归模型。在1012名患者中,572名(59%)患有晚期癌症。经单独测试,与大学学历相比,义务教育后学历、学徒身份且无职业培训、失业、领取残疾抚恤金、低层级工作、蓝领工作以及低收入与疾病进展几率增加相关。医疗保险和社区规模与晚期癌症无关。联合建模显示,有证据表明失业(优势比(OR)1.7,CI 1.0 - 2.8)、残疾抚恤金(OR 1.8,CI 1.0 - 3.2)和极低收入(OR 2.6,CI 1.1 - 6.1)对疾病晚期可能性有独立影响。即便在医疗保健可及性平等的系统中也出现这些社会经济梯度,这令人极为担忧。
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