Colorectal Surgical Unit, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
ANZ J Surg. 2022 Nov;92(11):2808-2815. doi: 10.1111/ans.18081. Epub 2022 Oct 3.
Social disparities in cancer survival have been demonstrated in Australia despite a universal healthcare insurance system. Colorectal cancer is common, and reasons for survival disparities related to socioeconomic status need to be investigated and addressed. The aim is to evaluate the current Australian literature concerning the impact of socioeconomic status on colorectal cancer survival and stage at presentation.
A systematic search of PUBMED, EMBASE, SCOPUS and Clarivate Web of Science databases from January 2010 to March 2022 was performed. Studies investigating the impact of socioeconomic status on colorectal stage at presentation or survival in Australia were included. Data were extracted on author, year of publication, state or territory of origin, patient population, other exposure variables, outcomes and findings and adjustments made.
Of the 14 articles included, the patient populations examined varied in size from 207 to 100 000+ cases. Evidence that socioeconomic disadvantage was associated with poorer survival was demonstrated in eight of 12 studies. Evidence of effect on late stage at presentation was demonstrated in two of seven studies. Area-level measures were commonly used to assess socioeconomic status, with varying indices utilized.
There is limited evidence that socioeconomic status is associated with late-stage at presentation. More studies provide evidence of an association between socioeconomic disadvantage and poorer survival, especially larger studies utilizing less clinically-detailed cancer registry data. Further investigation is required to analyse why socioeconomic disadvantage may be associated with poorer survival.
尽管澳大利亚拥有全民医疗保险制度，但仍存在癌症生存方面的社会差异。结直肠癌较为常见，需要调查和解决与社会经济地位相关的生存差异的原因。目的是评估目前澳大利亚关于社会经济地位对结直肠癌生存和就诊时分期影响的文献。
对 PUBMED、EMBASE、SCOPUS 和 Clarivate Web of Science 数据库从 2010 年 1 月至 2022 年 3 月进行了系统检索。纳入了研究澳大利亚社会经济地位对结直肠癌就诊时分期或生存影响的研究。提取了作者、发表年份、来源州或地区、患者人群、其他暴露变量、结局和发现以及调整因素的数据。
在纳入的 14 篇文章中，检查的患者人群规模从 207 例到 100000+例不等。12 项研究中有 8 项表明社会经济劣势与较差的生存相关。7 项研究中有 2 项表明与晚期就诊相关。区域水平的措施常用于评估社会经济地位，使用了不同的指标。
有有限的证据表明社会经济地位与晚期就诊相关。更多的研究提供了社会经济劣势与较差生存之间存在关联的证据，特别是利用较少临床详细的癌症登记数据的更大规模研究。需要进一步研究分析为什么社会经济劣势可能与较差的生存相关。
