Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
PLoS One. 2020 Jan 30;15(1):e0228551. doi: 10.1371/journal.pone.0228551. eCollection 2020.
Despite overall improvements in cancer survival due to earlier diagnosis and better treatment, socio-economically disadvantaged people have lower cancer survival than more advantaged people. We aimed to examine differences in cancer survival by area-level socio-economic disadvantage in Victoria, Australia and assess whether these inequalities varied by year of diagnosis, age at diagnosis, time since diagnosis and sex. Cases diagnosed with a first primary cancer in 2001-2015 were identified using the Victorian Cancer Registry and followed to the end of 2016. Five-year net survival and the excess risk of death due to a cancer diagnosis were estimated. People living in more disadvantaged areas had lower five-year survival than residents of less disadvantaged regions for 21 of 29 cancer types: head and neck, oesophagus, stomach, colorectum, anus/anal canal, liver, gallbladder/biliary tract, pancreas, lung, melanoma, connective/soft tissue, female breast, ovary, prostate, kidney, bladder, brain and central nervous system, unknown primary, non-Hodgkin lymphoma, multiple myeloma and leukemia. The observed lower survival in more deprived regions persisted over time, except head and neck cancer, for which the gap in survival has widened. Socio-economic inequalities in survival decreased with increasing age at diagnosis for cancers of connective/soft tissue, bladder and unknown primary. For colorectal cancer, the observed survival disadvantage in lower socio-economic regions was greater for men than for women, while for brain and central nervous system tumours, it was larger for women. Cancer survival is generally lower for residents of more socio-economically disadvantaged areas. Identifying the underlying reasons for these inequalities is important and may help to identify effective interventions to increase survival for underprivileged cancer patients.
尽管由于早期诊断和更好的治疗，癌症的总体存活率有所提高，但社会经济处于不利地位的人群的癌症存活率仍低于处于更有利地位的人群。本研究旨在检查澳大利亚维多利亚州按地区社会经济劣势划分的癌症存活率差异，并评估这些不平等是否因诊断年份、诊断时的年龄、诊断后时间和性别而异。通过维多利亚癌症登记处确定了 2001-2015 年间诊断出的首例原发性癌症病例，并随访至 2016 年底。估计了五年净生存率和因癌症诊断而导致的超额死亡风险。29 种癌症中有 21 种，生活在较不利地区的人五年生存率低于较不利地区的居民：头颈部、食管、胃、结直肠、肛门/肛管、肝、胆囊/胆道、胰腺、肺、黑色素瘤、结缔组织/软组织、女性乳房、卵巢、前列腺、肾、膀胱、脑和中枢神经系统、未知原发性、非霍奇金淋巴瘤、多发性骨髓瘤和白血病。除头颈部癌症外，观察到的较贫困地区的生存率下降趋势持续存在，且生存率差距扩大。对于结缔组织/软组织、膀胱和未知原发性癌症，随着诊断时年龄的增加，生存不平等现象有所减少。对于结直肠癌，在社会经济地位较低的地区，男性的观察到的生存劣势大于女性，而对于脑和中枢神经系统肿瘤，女性的生存劣势更大。总体而言，社会经济处于不利地位地区的居民癌症存活率较低。确定这些不平等现象的根本原因很重要，这可能有助于确定增加贫困癌症患者生存机会的有效干预措施。
