SOCIOECONOMIC VARIATION IN CANCER SURVIVAL IN THE SOUTHEASTERN NETHERLANDS, 1980-1989

Background. The survival rates of patients with cancer by socioeconomi c status (SES) has never been investigated in the Netherlands, a count ry characterized by good general access to health care services. The a ssociation between socioeconomic status and survival from cancer of th e lung (n = 4591), breast (n = 3928), colorectum (n = 3558), prostate (n = 1484), and stomach (n = 1455) was studied, and the impact of some prognostic factors (stage at diagnosis, histologic type, and treatmen t) on this association was assessed. Methods. Subjects were patients w ho were diagnosed from 1980 to 1989 and included in the population-bas ed Eindhoven Cancer Registry in the Southeastern Netherlands. The pati ents were classified by socioeconomic status based on their postal cod e of residence at the time of diagnosis (3 or 5 categories). The follo w-up ended July 1, 1991, at which time relative survival rates and haz ard ratios were calculated. Results. A more favorable relative surviva l for patients living in high SES areas was found for those with cance r of the lung, breast, colorectum, and prostate, whereas for those wit h stomach cancer, lower survival was found for patients living in high SES areas. For cancer of the lung, colorectum, and prostate, the soci oeconomic variation in survival could not be explained by the distribu tion of the prognostic factors stage, histologic type, and treatment. For patients with breast and stomach cancer, the socioeconomic variati on in survival could be ascribed mainly to differences in the percenta ge of patients diagnosed with a metastasis. Conclusions. Socioeconomic variation in survival from a number of common cancer sites exists in the Netherlands, despite the fairly equal access to health care. servi ces for different socioeconomic groups. Most of the variation could no t be explained by the differential distribution of stage, histologic t ype, and treatment across SES categories.