Socioeconomic inequalities in cancer survival in England and Wales

BACKGROUND. Cancer survival often has been reported as lower for the poor t han the rich, but, to the authors' knowledge, systematic national estimates of deprivation gradients in survival over long periods of time have not be en available. METHODS. The authors estimated national population-based survival rates for almost 3 million people who were diagnosed with 1 of 58 types of cancers ( 47 in adults, 11 in children) in England and Wales during the 20-year perio d 1971-1990 and followed through December 31, 1995. Cancer patients were as signed by their address at diagnosis to 1 of 5 categories (quintiles of the national distribution) of material deprivation by using a standard index d erived from census data on unemployment, car ownership, household overcrowd ing, and social class;hat was available for all 109,000 census tracts in Gr eat Britain. The authors used relative survival rates: the ratio of observe d survival among the cancer patients to the survival that would have been e xpected if they had had the same background mortality as the general popula tion. Background mortality differed widely among socioeconomic categories, and the authors constructed life tables from raw national mortality data by gender, single year of age, calendar period of death, and socioeconomic ca tegory to adjust for it. The authors used variance-weighted lease squares r egression to estimate both time trends in age standardized survival and soc ioeconomic gradients in surrival. The number of avoidable deaths Was estima ted from the observed mortality excess compared with the expected mortality in each group of patients. RESULTS. Survival rose steadily for most cancers over 25 years to 1995 in E ngland and Wales, but inequalities in survival between patients Living in r ich and poor areas were geographically widespread and persistent over this period of time. These patterns existed for 44 of 47 adult cancers examined but not for 11 childhood cancers. These inequalities in survival represente d more than 2500 deaths that would have been avoided each year if all cance r patients had had the same chance of surviving up to 5 years after diagnos is as patients in the most affluent;group. CONCLUSIONS, The largest national cancer survival study has provided strong evidence of systematic disadvantage in outcome among patients who;lived in poorer districts compared with those who lived in wealthier districts. Can cer 2001; 91:208-16 (C) 2001 American Cancer Society.