Kogevinas M, Porta M
Institut Municipal d'Investigació Mèdica, Universitat Autònoma de Barcelona, Spain.
IARC Sci Publ. 1997(138):177-206.
In the discussion of social inequalities in health there has been much debate on the role of medical care. Large differences in cancer incidence and mortality from cancer have been consistently observed. To understand the potential importance of socioeconomic differences in prompt detection and treatment of cancer it is essential to have data on cancer survival. These have been examined less extensively than differences in cancer incidence. We have reviewed 42 studies on social class differences in cancer survival. Twenty-three studies were conducted in North America, and 15 in western European countries. Twenty-three studies were carried out through population-based cancer registries and 17 through hospitals or hospital-based registries. Seven studies examined survival differences for multiple cancer sites. Social class differences in cancer survival appear remarkably general. Patients in low social classes had consistently poorer survival than those in high social classes. The magnitude of the differences for most cancer sites was fairly narrow, with most relative risks falling between 1 and 1.5. The widest differences were observed for cancers of good prognosis and specifically cancers of the female breast, corpus uteri, bladder and colon. The pattern of the social differences in survival did not vary consistently by sex, country, or source of the study population and did not depend on the socioeconomic indicator used.
在关于健康方面社会不平等的讨论中，对于医疗保健的作用存在诸多争论。人们一直观察到癌症发病率和癌症死亡率存在巨大差异。为了解社会经济差异在癌症早期发现和治疗中的潜在重要性，掌握癌症生存率数据至关重要。与癌症发病率差异相比，对这些数据的研究不够广泛。我们回顾了42项关于癌症生存率社会阶层差异的研究。其中23项研究在北美进行，15项在西欧国家进行。23项研究通过基于人群的癌症登记处开展，17项通过医院或基于医院的登记处开展。7项研究考察了多个癌症部位的生存差异。癌症生存率的社会阶层差异似乎非常普遍。社会阶层较低的患者生存率一直低于社会阶层较高的患者。大多数癌症部位的差异幅度相当小，大多数相对风险在1到1.5之间。在预后良好的癌症中，尤其是女性乳腺癌、子宫体癌、膀胱癌和结肠癌，观察到的差异最大。生存方面的社会差异模式在性别、国家或研究人群来源方面并没有始终如一的变化，也不取决于所使用的社会经济指标。
