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社会经济地位对就诊时癌症分期的影响:德国一项基于大型医院研究的结果

Impact of socio-economic position on cancer stage at presentation: Findings from a large hospital-based study in Germany.

作者信息

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

机构信息

Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Mainz, Germany.

University Cancer Centre, Mainz, Germany.

出版信息

Int J Cancer. 2016 Oct 15;139(8):1696-702. doi: 10.1002/ijc.30212. Epub 2016 Jun 11.


DOI:10.1002/ijc.30212
PMID:27244597
Abstract

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.

摘要

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。

相似文献

[1]
Impact of socio-economic position on cancer stage at presentation: Findings from a large hospital-based study in Germany.

Int J Cancer. 2016-10-15

[2]
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[3]
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[4]
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[5]
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Eur J Public Health. 2015-12

[6]
Effects of socio-economic and demographic factors in delayed reporting and late-stage presentation among patients with breast cancer in a major cancer hospital in South India.

Asian Pac J Cancer Prev. 2008

[7]
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[8]
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[9]
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[10]
[Job insecurity, unemployment and health: results from the health examination centers of the French General Health Insurance].

Rev Epidemiol Sante Publique. 2009-6

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Inquiry. 2024

[2]
Effects of socioeconomic status on cancer patient survival: counterfactual event-based mediation analysis.

Cancer Causes Control. 2021-1

[3]
A matched-pair analysis on survival and response rates between German and non-German cancer patients treated at a Comprehensive Cancer Center.

BMC Cancer. 2019-10-30

[4]
Determination of effective factors on geographic distribution of the incidence of colorectal cancer in Tehran using geographically weighted Poisson regression model.

Med J Islam Repub Iran. 2019-3-27

[5]
The association of socioeconomic status with quality of life in cancer patients over a 6-month period using individual growth models.

Support Care Cancer. 2019-1-9

[6]
Occupational inequalities in female cancer incidence in Japan: Hospital-based matched case-control study with occupational class.

SSM Popul Health. 2018-6-8

[7]
Income and health-related quality of life among prostate cancer patients over a one-year period after radical prostatectomy: a linear mixed model analysis.

Qual Life Res. 2017-9

[8]
Socio-economic disparities in long-term cancer survival-10 year follow-up with individual patient data.

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