Socioeconomic and demographic inequalities in stage at diagnosis and survival among colorectal cancer patients: evidence from a Swiss population-based study.

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State: Public
Version: Final published version
Serval ID
serval:BIB_D9A23AF8C8BE
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Socioeconomic and demographic inequalities in stage at diagnosis and survival among colorectal cancer patients: evidence from a Swiss population-based study.
Journal
Cancer medicine
Author(s)
Feller A., Schmidlin K., Bordoni A., Bouchardy C., Bulliard J.L., Camey B., Konzelmann I., Maspoli M., Wanner M., Zwahlen M., Clough-Gorr K.M.
Working group(s)
SNC and the NICER Working Group
Contributor(s)
Egger M., Spoerri A., Puhan M., Bopp M., Künzli N., Bochud M., Oris M.
ISSN
2045-7634 (Electronic)
ISSN-L
2045-7634
Publication state
Published
Issued date
04/2018
Peer-reviewed
Oui
Volume
7
Number
4
Pages
1498-1510
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
Socioeconomic inequalities in cancer stage at diagnosis and survival are important public health issues. This study investigates the association between socioeconomic position (SEP) and colorectal cancer (CRC) stage at diagnosis and survival in Switzerland, a European country with highest level of medical facilities and life expectancy. We used population-based CRC data from seven Swiss cantonal cancer registries 2001-2008 (N = 10,088) linked to the Swiss National Cohort (SNC). Follow-up information was available until the end of 2013. SEP was estimated based on education. The association between cancer stage and SEP was assessed using logistic regression models including cancer localization (colon/rectum), sex, age, civil status, urbanity of residence, language region, and nationality (Swiss/non-Swiss). Survival was analyzed using competing risk regressions reporting subhazard ratios (SHRs) for the risk of dying due to CRC. We observed a social gradient for later stage CRC with adjusted odds ratios (ORs) of 1.11 (95% CI: 0.97-1.19) and 1.28 (95% CI: 1.08-1.50) for middle and low SEP compared to high SEP. Further, single compared to married people had elevated odds of being diagnosed at later stages. Survival was lower in patients with CRC with low SEP in the unadjusted model (SHR: 1.18, 95% CI: 1.07-1.30). After adjustment for stage at diagnosis and further sociodemographic characteristics, significant survival inequalities by SEP disappeared but remained for non-Swiss compared to Swiss citizens and for patients living in nonurban areas compared to their urban counterparts. Swiss public health strategies should facilitate equal access to CRC screening and optimal CRC care for all social groups and in all regions of Switzerland.
Keywords
Adult, Aged, Aged, 80 and over, Colorectal Neoplasms/epidemiology, Colorectal Neoplasms/mortality, Colorectal Neoplasms/pathology, Female, Health Status Disparities, Humans, Male, Middle Aged, Neoplasm Staging, Odds Ratio, Population Surveillance, Registries, Risk Factors, Socioeconomic Factors, Survival Rate, Switzerland/epidemiology, Colorectal cancer, health inequalities, socioeconomic position, stage at diagnosis, survival
Pubmed
Web of science
Open Access
Yes
Create date
08/03/2018 14:02
Last modification date
20/08/2019 15:58
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