Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study
Metadatos
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Luque Fernández, Miguel Ángel; Redondo Sánchez, Daniel; Rodríguez Barranco, Miguel; Salamanca Fernández, Elena; Fernández-Navarro, Pablo; Sánchez, María JoséEditorial
DOVE MEDICAL PRESS LTD
Materia
Socioeconomic inequalities Colorectal cancer Survival Population-based epidemiology Epidemiological methods Multilevel
Fecha
2020Referencia bibliográfica
Luque-Fernandez, M. A., Redondo-Sánchez, D., Rodríguez-Barranco, M., Chang-Chan, Y. L., Salamanca-Fernández, E., Núñez, O., Fernandez-Navarro, P., Pollán, M., & Sánchez, M. J. (2020). Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study. Clinical epidemiology, 12, 797–806. [https://doi.org/10.2147/CLEP.S261355]
Patrocinador
Instituto de Salud Carlos III EU-FEDER-FIS PI-18/01593 CP17/00206-EU-FEDER; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiologia y Salud Publica); Cancer Epidemiological Surveillance Subprogram (VICA) from the Instituto de Salud Carlos III, Madrid, Spain; Andalusian Department of Health PI-0152/2017Resumen
Background: Colorectal cancer (CRC) is the most frequently diagnosed cancer in Spain.
Socioeconomic inequalities in cancer survival are not documented in Spain. We aim to study
the association of socioeconomic inequalities with overall mortality and survival among
CRC patients in southern Spain.
Methods: We conducted a multilevel population-based cohort study, including CRC cases
for the period 2011–2013. The study time-to-event outcome was death, and the primary
exposure was CRC patients’ socioeconomic status assessed by the Spanish deprivation index
at the census tract level. We used a mixed-effects flexible hazard model, including census
tract as a random intercept, to derive overall survival estimates by deprivation.
Results: Among 3589 CRC patients and 12,148 person-years at risk (pyr), 964 patients died
before the end of the follow-up. Mortality by deprivation showed the highest mortality rate
for the most deprived group (96.2 per 1000 pyr, 95% CI: 84.0–110.2). After adjusting for
sex, age, cancer stage, and the area of residence, the most deprived had a 60% higher excess
mortality risk than the less deprived group (excess mortality risk ratio: 1.6, 95% CI: 1.1–2.3).
Conclusions: We found a consistent association between deprivation and CRC excess
mortality and survival. The reasons behind these inequalities need further investigation in
order to improve equality cancer outcomes in all social groups.
Keywords: socioeconomic inequalities, colorectal cancer, survival, population-based