Belgian Cancer Registry, Brussels, Belgium.
Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium.
Cancer Epidemiol Biomarkers Prev. 2021 Jan;30(1):45-52. doi: 10.1158/1055-9965.EPI-20-0721. Epub 2020 Oct 20.
Socioeconomic status (SES) is an important factor in cancer survival; however, results are heterogeneous and linked to characteristics of the study population and health care system. This population-based cohort study evaluates the association between individual-level socioeconomic and demographic factors and cancer survival for the first time in Belgium.
From the Belgian Cancer Registry, we identified 109,591 patients diagnosed between 2006 and 2013 with one of eight common cancer types. Information on treatment, socioeconomic parameters, and vital status were retrieved from multiple data sources and linked using a unique personal identification number. The outcome was 5-year observed survival. Associations between survival and socioeconomic and demographic factors were assessed using multivariable Cox proportional-hazard regression models.
Lower income, unemployment, and living alone were all associated with worse cancer survival. These associations were most pronounced for certain lifestyle-related cancer types (e.g., head and neck cancers) and those with good to moderate prognosis (e.g., colorectal and female breast cancer).
These results indicate that, despite a comprehensive and nationwide health insurance program in which equity in rights and access to health care are pursued, SES is associated with disparities in cancer survival in Belgium.
This population-based study with individual-level socioeconomic information of more than 100,000 patients with cancer identifies patient groups that may be at highest risk for socioeconomic disparities in cancer survival. Reasons behind the observed disparities are multiple and complex and should be further examined. Health policy interventions should consider the observed deprivation gap to plan targeted actions.
社会经济地位（SES）是癌症生存的一个重要因素；然而，结果存在异质性，并与研究人群和医疗保健系统的特点有关。本基于人群的队列研究首次在比利时评估了个体社会经济和人口统计学因素与癌症生存之间的关联。
我们从比利时癌症登记处确定了 109591 名于 2006 年至 2013 年间被诊断出患有八种常见癌症类型之一的患者。通过使用唯一的个人识别号码，从多个数据源检索有关治疗、社会经济参数和生存状态的信息，并将其联系起来。结果是 5 年观察生存率。使用多变量 Cox 比例风险回归模型评估生存与社会经济和人口统计学因素之间的关联。
较低的收入、失业和独居都与癌症生存率下降有关。这些关联在某些与生活方式相关的癌症类型（例如头颈部癌症）和预后较好至中等的癌症类型（例如结直肠癌和女性乳腺癌）中最为明显。
这些结果表明，尽管比利时实行了一项全面的、全国性的医疗保险计划，旨在追求权利平等和获得医疗保健的机会，但 SES 与比利时癌症生存率的差异有关。
这项基于人群的研究使用了超过 100,000 名癌症患者的个体社会经济信息，确定了可能面临癌症生存率中 SES 差异风险最高的患者群体。观察到的差异背后的原因是多方面且复杂的，应进一步研究。卫生政策干预措施应考虑到观察到的贫困差距，以规划有针对性的行动。
