Wu Chin-Chia, Chang Chun-Ming, Hsu Ta-Wen, Lee Cheng-Hung, Chen Jian-Han, Huang Chih-Yuan, Lee Ching-Chih
Division of Colorectal Surgery Division of General Surgery, Department of Surgery Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi School of Medicine, Tzu Chi University, Hualien Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital School of Medicine, National Defense Medical Center, Taipei, Taiwan.
Medicine (Baltimore). 2016 Jul;95(27):e4140. doi: 10.1097/MD.0000000000004140.
Esophageal cancer is the sixth leading cause of cancer mortality. More than 90% of patients with esophageal cancer in Taiwan have squamous cell carcinoma. Survival of such patients is related to socioeconomic status (SES). We studied the association between SES (individual and neighborhood) and the survival of working-age patients with esophageal cancer in Taiwan. A population-based study was conducted of 4097 patients diagnosed with esophageal cancer between 2002 and 2006. Each was traced for 5 years or until death. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income and dichotomized into advantaged or disadvantaged. Multilevel logistic regression was used to compare the survival rates by SES group after adjustment for possible confounding and risk factors. Hospital and neighborhood SES were used as random effects in multilevel logistic regression. In patients younger than 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjustment for patient characteristics, esophageal cancer patients with high individual SES had a 39% lower risk of mortality than those with low individual SES (odds ratio 0.61, 95% confidence interval 0.48-0.77). Patients living in disadvantaged areas with high individual SES were more likely to receive surgery than those with low SES (odds ratio 1.45, 95% confidence interval 1.11-1.89). Esophageal cancer patients with low individual SES have the worst 5-year survival, even with a universal healthcare system. Public health, education, and social welfare programs should address the inequality of esophageal cancer survival.
食管癌是癌症死亡的第六大主要原因。台湾超过90%的食管癌患者患有鳞状细胞癌。这类患者的生存率与社会经济地位（SES）有关。我们研究了SES（个体和社区层面）与台湾劳动年龄食管癌患者生存率之间的关联。对2002年至2006年间诊断为食管癌的4097名患者进行了一项基于人群的研究。对每名患者进行了5年的追踪或直至其死亡。个体SES由入组者的工作类别定义。社区SES基于家庭收入，并分为优势或劣势两类。在对可能的混杂因素和风险因素进行调整后，使用多水平逻辑回归比较SES组的生存率。在多水平逻辑回归中，将医院和社区SES用作随机效应。在65岁以下的患者中，个体SES低且生活在劣势社区的患者5年总生存率最差。在对患者特征进行调整后，个体SES高的食管癌患者的死亡风险比个体SES低的患者低39%（优势比0.61，95%置信区间0.48 - 0.77）。个体SES高但生活在劣势地区的患者比SES低的患者更有可能接受手术（优势比1.45，95%置信区间1.11 - 1.89）。即使有全民医疗保健系统，个体SES低的食管癌患者5年生存率最差。公共卫生、教育和社会福利项目应解决食管癌生存方面的不平等问题。
