Influence of socioeconomic status on prognosis of colorectal cancer. A population-based study in Côte D'Or, France.

BACKGROUND

The prognostic significance of the socioeconomic status of patients treated for colorectal cancer, although stated in some studies, remains controversial.

METHODS

The authors studied a population-based series of 771 patients with colorectal cancer diagnosed in Cote D'Or, France, between January 1976 and December 1980. Survival was studied for the first 5 years after diagnosis. The relationship between socioeconomic status, assessed by comfort of housing, and the main clinical prognostic factors was examined. The influence of comfort of housing on prognosis was studied with the Cox model, while controlling for these factors. Interactions between type of housing and other prognostic factors also were tested.

RESULTS

Compared with patients living in a comfortable house, patients in the medium or no-comfort categories were more likely to receive diagnosis at an advanced stage (P = 0.03) and be treated by palliative therapy (P = 0.0005). After adjustment for these factors and age, sex, place of residence, and tumor site, patients living in no comfort had a twofold higher risk of dying during the follow-up period compared with patients living in comfortable housing, with the relative risk being 1.5 for the medium comfort category (95% confidence intervals, 1.3-3.2 and 1.2-1.7, respectively). This effect was more remarkable in patients with early-stage tumors than in patients with advanced tumors.

CONCLUSIONS

Such findings should prompt public health measures for earlier access to care structures for people in a lower social class and research for a better understanding of the host-tumor relationship.