Dabbikeh Andrew, Peng Yingwei, Mackillop William J, Booth Christopher M, Zhang-Salomons Jina
Affiliations: Departments of Public Health Sciences (Dabbikeh, Peng, Mackillop, Zhang-Salomons) and Oncology (Mackillop, Booth, Zhang-Salomons); Division of Cancer Care and Epidemiology (Peng, Mackillop, Booth, Zhang-Salomons), Cancer Research Institute, Queen's University, Kingston, Ont.
CMAJ Open. 2017 Sep 6;5(3):E682-E689. doi: 10.9778/cmajo.20170025.
Cancer survival is known to be associated with socioeconomic status. The income gap between the richer and poorer segments of the population has widened over the last 20 years in Canada. The purpose of this study was to investigate temporal trends in disparities in cancer-specific survival related to socioeconomic status in Ontario.
There were 920 334 cancer cases between 1993 and 2009 in the Ontario Cancer Registry. We linked median household income from the Canadian census to the registry. We calculated 5-year cancer-specific survival rates for all cancers combined and for specific cancer sites by socioeconomic status quintile and year of diagnosis, and modelled time to death using Cox regression.
Between 1993 and 2009, for all cancers combined, the hazard of death decreased by 3.1% (hazard ratio [HR] 0.969 [95% confidence interval (CI) 0.967-0.971]) per year in the richest quintile and by 1.2% (HR 0.988 [95% CI 0.987-0.990]) per year in the poorest quintile. The corresponding values for breast cancer were 4.3% (HR 0.957 [95% CI 0.951-0.964]) and 2.0% (HR 0.980 [95% CI 0.975-0.986]); for lung cancer, 1.4% (HR 0.986 [95% CI 0.982-0.990]) and 0.3% (HR 0.997 [95% CI 0.995-1.000]); for colorectal cancer, 3.7% (HR 0.963 [95% CI 0.958-0.968]) and 1.8% (HR 0.982 [95% CI 0.978-0.985]); and for head and neck cancer, 3.1% (HR 0.969 [95% CI 0.958-0.979]) and 1.0% (HR 0.990 [95% CI 0.983-0.996]).
Between 1993 and 2009, cancer-specific survival in Ontario improved more among patients from affluent communities than among those from poorer communities. This phenomenon cannot be explained by increased disparity in income.
癌症生存率已知与社会经济地位相关。在过去20年里，加拿大贫富人群之间的收入差距不断扩大。本研究的目的是调查安大略省与社会经济地位相关的特定癌症生存率差异的时间趋势。
安大略癌症登记处1993年至2009年期间有920334例癌症病例。我们将加拿大人口普查中的家庭收入中位数与登记处数据相链接。我们按社会经济地位五分位数和诊断年份计算了所有癌症综合以及特定癌症部位的5年癌症特异性生存率，并使用Cox回归对死亡时间进行建模。
1993年至2009年期间，对于所有癌症综合而言，最富裕五分位数人群的年死亡风险下降3.1%（风险比[HR]0.969[95%置信区间(CI)0.967 - 0.971]），最贫穷五分位数人群的年死亡风险下降1.2%（HR 0.988[95%CI 0.987 - 0.990]）。乳腺癌的相应数值分别为4.3%（HR 0.957[95%CI 0.951 - 0.964]）和2.0%（HR 0.980[95%CI 0.975 - 0.986]）；肺癌分别为1.4%（HR 0.986[95%CI 0.982 - 0.990]）和0.3%（HR 0.997[95%CI 0.995 - 1.000]）；结直肠癌分别为3.7%（HR 0.963[95%CI 0.958 - 0.968]）和1.8%（HR 0.982[95%CI 0.978 - 0.985]）；头颈癌分别为3.1%（HR 0.969[95%CI 0.958 - 0.979]）和1.0%（HR 0.990[95%CI 0.983 - 0.996]）。
1993年至2009年期间，安大略省富裕社区患者的特定癌症生存率比贫困社区患者提高得更多。这种现象无法用收入差距扩大来解释。
