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 bee n 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 Waifs 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 derived from census data on unemployment, car ownership, household overcrow ding, and social class that was available for all 109,000 census tracts in Great Britain, The authors used relative survival rate: the ratio of observ ed survival among the cancer patients to the survival that would have been expected if they had had the same background mortality as the general popul ation. Background mortality differed widely among socioeconomic categories, and the authors constructed life tables from raw national mortality data b y gender, single year of age, calendar period of death, and socioeconomic c ategory to adjust for it. The authors used variance-weighted least squares regression to estimate both time trends in age standardized survival and so cioeconomic gradients ill survival. The number of avoidable deaths was esti mated from the observed mortality excess compared with the expected mortali ty 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 but 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 mast affluent group. CONCLUSIONS. The largest notional 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.