SOCIAL-CLASS AND CANCER SURVIVAL IN TURIN, ITALY

Study objective - This study aimed to investigate social differences i n cancer survival in residents of Turin, Italy. Design - Incident case s from the Piedmont cancer registry were linked to municipality files and 1981 census data, and followed up from 1985-92. The census provide d data on education and housing tenure, which were used as indicators of social class. The case fatality ratio (CFR) was estimated through a proportional hazard model, with socioeconomic indicators as risk fact ors. Main results - Educated people of both sexes showed better surviv al for all malignant neoplasms together and, particularly among men, f or tumours which show a better prognosis such as cancer of colon-rectu m, larynx, prostate, and bladder The relative risk of dying, compared with people who had only primary school education, decreased from 0.91 for those with middle school education to 0.67 for those who held a u niversity degree. Conclusion - There were major differences in cancer survival showing a poorer outcome for those from the lower social stra tum, particularly in sites for which effective treatments are availabl e. Since is unlikely that the observed differences could be totally ex plained by extraneous factors, such as competing mortality, it is conc luded that even in a country where the health system offers universal coverage, non-financial barriers act by creating differences in opport unities for better care.