Mackillop W J, Zhang-Salomons J, Groome P A, Paszat L, Holowaty E
Department of Oncology, Queen's University, Kingston, Toronto, Canada.
J Clin Oncol. 1997 Apr;15(4):1680-9. doi: 10.1200/JCO.1997.15.4.1680.
It is known that the socioeconomic status (SES) of the patient is associated with cancer survival in the United States. The purpose of this study was to determine whether the association between SES and survival is also present in Canada, a society with a comprehensive, universal, health insurance program.
A population-based cancer registry was used to identify the 357,530 cases of invasive cancer diagnosed in the Canadian province of Ontario between 1982 and 1991. Information from the 1986 Canadian census was linked to the registry and used to describe the SES of the area in which each patient resided. Cox regression was used to describe the association between median household income and survival while controlling for age, sex, and the region in which the patient resided. The Cox model was fitted in a competing risk framework to assess the association between income and the probability of specific causes of death.
Lung cancer and cancers of the head and neck region were relatively more common in poor-income communities, and cancers of the breast, CNS, and testis were relatively more common in richer communities. A strong and statistically significant association between community income and survival was observed in cancers of the head and neck region, cervix, uterus, breast, prostate, bladder, and esophagus. Smaller, but significant associations were seen in cancers of the lung and rectum. No significant association between community income and survival was observed in cancers of the stomach, colon, pancreas, or ovary. Analysis of the cause of death showed that community income is associated both with the probability of death from cancer and with the probability of death from other causes.
Although Canada's health care system was designed to provide equitable access to equivalent standards of care, it does not prevent a difference in cancer survival between rich and poor communities.
众所周知，在美国患者的社会经济地位（SES）与癌症生存率相关。本研究的目的是确定在加拿大这个拥有全面、全民医疗保险计划的社会中，SES与生存率之间是否也存在关联。
利用基于人群的癌症登记处来识别1982年至1991年间在加拿大安大略省诊断出的357,530例浸润性癌症病例。1986年加拿大人口普查的信息与该登记处相链接，并用于描述每位患者居住地区的SES。在控制年龄、性别和患者居住地区的同时，使用Cox回归来描述家庭收入中位数与生存率之间的关联。在竞争风险框架中拟合Cox模型，以评估收入与特定死因概率之间的关联。
肺癌和头颈部癌症在低收入社区相对更为常见，而乳腺癌、中枢神经系统癌和睾丸癌在富裕社区相对更为常见。在头颈部癌症、子宫颈癌、子宫癌、乳腺癌、前列腺癌、膀胱癌和食管癌中，观察到社区收入与生存率之间存在强烈且具有统计学意义的关联。在肺癌和直肠癌中观察到较小但显著的关联。在胃癌、结肠癌、胰腺癌或卵巢癌中未观察到社区收入与生存率之间的显著关联。对死因的分析表明，社区收入与癌症死亡概率以及其他原因导致的死亡概率均相关。
尽管加拿大的医疗保健系统旨在提供公平获得同等医疗标准的机会，但它并不能防止富裕社区和贫困社区在癌症生存率上存在差异。
