Background. Socioeconomic factors account for a significant part of the total burden of disease in the population of both industrialized and less developed societies. We aimed to analyze cancer risks in relationship to different socioeconomic status (SES) in the Lazio region. The main goal is to determine the magnitude of social inequalities in the whole disease pathway: from incidence to mortality. This study will focus on four common cancers in Italy such as lung cancer, breast cancer, colorectal cancer, and stomach cancer. Data and Methods. Incident and prevalent cases will be identified through the Hospital Information System since the regional cancer registry has not been established yet. Estimates will be validated at a micro-level using two local registries and at a macro-level using the MIAMOD method (Mortality and Incidence Analysis MODel). Area-based measures of SES will be calculated from the 2011 census data. Results. Over the years 2009-2015, cross-sectional analysis’ results showed 11% and 6% excess risk of cancer, after adjusting for age, among men in disadvantaged neighborhoods living in the Municipality of Rome and in the other districts, respectively. The socioeconomic gradients were less pronounced among women, except for stomach cancer in Rome. A direct association was confirmed for breast cancer: the higher the SES, the higher the risk of cancer. Longitudinal analyses showed a significant 10% and 8% excess risk of cancer among men and women, respectively, living in disadvantaged neighborhoods even when we controlled for individual educational level and other confounders such as age, marital status, and place of birth. Educational gradients were more pronounced than those observed across different area-based SES levels, particularly for breast, stomach, and lung cancers. Cross-sectional and longitudinal analyses also provide evidence of an adverse effect of low socioeconomic status on cancer mortality, decreasing with increasing SES. The overall excess risk that we observed in the most deprived areas across the region ranged between 19% and 33% among men, and 8-15% among women. Women living in disadvantage neighborhoods diagnosed with metastatic breast cancer had twice the excess hazard of death than women with metastatic breast cancer living in affluent areas. Conclusions. Our results confirm an association between socioeconomic status and cancer outcomes and show inequalities particularly marked among men and within the Municipality of Rome.

Inequalities in cancer incidence, mortality, and survival by socioeconomic status among residents in the Lazio region / Santi, Flavia. - (2018 Feb 23).

Inequalities in cancer incidence, mortality, and survival by socioeconomic status among residents in the Lazio region

SANTI, FLAVIA
23/02/2018

Abstract

Background. Socioeconomic factors account for a significant part of the total burden of disease in the population of both industrialized and less developed societies. We aimed to analyze cancer risks in relationship to different socioeconomic status (SES) in the Lazio region. The main goal is to determine the magnitude of social inequalities in the whole disease pathway: from incidence to mortality. This study will focus on four common cancers in Italy such as lung cancer, breast cancer, colorectal cancer, and stomach cancer. Data and Methods. Incident and prevalent cases will be identified through the Hospital Information System since the regional cancer registry has not been established yet. Estimates will be validated at a micro-level using two local registries and at a macro-level using the MIAMOD method (Mortality and Incidence Analysis MODel). Area-based measures of SES will be calculated from the 2011 census data. Results. Over the years 2009-2015, cross-sectional analysis’ results showed 11% and 6% excess risk of cancer, after adjusting for age, among men in disadvantaged neighborhoods living in the Municipality of Rome and in the other districts, respectively. The socioeconomic gradients were less pronounced among women, except for stomach cancer in Rome. A direct association was confirmed for breast cancer: the higher the SES, the higher the risk of cancer. Longitudinal analyses showed a significant 10% and 8% excess risk of cancer among men and women, respectively, living in disadvantaged neighborhoods even when we controlled for individual educational level and other confounders such as age, marital status, and place of birth. Educational gradients were more pronounced than those observed across different area-based SES levels, particularly for breast, stomach, and lung cancers. Cross-sectional and longitudinal analyses also provide evidence of an adverse effect of low socioeconomic status on cancer mortality, decreasing with increasing SES. The overall excess risk that we observed in the most deprived areas across the region ranged between 19% and 33% among men, and 8-15% among women. Women living in disadvantage neighborhoods diagnosed with metastatic breast cancer had twice the excess hazard of death than women with metastatic breast cancer living in affluent areas. Conclusions. Our results confirm an association between socioeconomic status and cancer outcomes and show inequalities particularly marked among men and within the Municipality of Rome.
23-feb-2018
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1075260
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