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. 2020 Jul 21:12:797-806.
doi: 10.2147/CLEP.S261355. eCollection 2020.

Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study

Miguel Angel Luque-Fernandez  1   2   3 , Daniel Redondo-Sánchez  1   2 , Miguel Rodríguez-Barranco  1   2   4 , Yoe-Ling Chang-Chan  1   4 , Elena Salamanca-Fernández  1   2 , Olivier Núñez  2   5 , Pablo Fernandez-Navarro  2   5 , Marina Pollán  2   5 , María-José Sánchez  1   2   4   6
Affiliations

Socioeconomic Inequalities in Colorectal Cancer Survival in Southern Spain: A Multilevel Population-Based Cohort Study

Miguel Angel Luque-Fernandez et al. Clin Epidemiol. .

Abstract

Background: Colorectal cancer (CRC) is the most frequently diagnosed cancer in Spain. Socioeconomic inequalities in cancer survival are not documented in Spain. We aim to study the association of socioeconomic inequalities with overall mortality and survival among CRC patients in southern Spain.

Methods: We conducted a multilevel population-based cohort study, including CRC cases for the period 2011-2013. The study time-to-event outcome was death, and the primary exposure was CRC patients' socioeconomic status assessed by the Spanish deprivation index at the census tract level. We used a mixed-effects flexible hazard model, including census tract as a random intercept, to derive overall survival estimates by deprivation.

Results: Among 3589 CRC patients and 12,148 person-years at risk (pyr), 964 patients died before the end of the follow-up. Mortality by deprivation showed the highest mortality rate for the most deprived group (96.2 per 1000 pyr, 95% CI: 84.0-110.2). After adjusting for sex, age, cancer stage, and the area of residence, the most deprived had a 60% higher excess mortality risk than the less deprived group (excess mortality risk ratio: 1.6, 95% CI: 1.1-2.3).

Conclusions: We found a consistent association between deprivation and CRC excess mortality and survival. The reasons behind these inequalities need further investigation in order to improve equality cancer outcomes in all social groups.

Keywords: colorectal cancer; epidemiological methods; multilevel; population-based epidemiology; socioeconomic inequalities; survival.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1
Relative survival probability, restricted mean survival time, and restricted mean survival time differences in years by levels of deprivation (Q5 vs Q1) among colorectal cancer patients in Granada, between 2011–2013, n = 3582. Notes: (A) Relative survival probability by the quintiles of deprivation. Solid line: Q5 and dashed line: Q1. (B) Restricted mean survival time in years by the quintiles of deprivation. Solid line: Q5 and dashed line: Q1. (C) Restricted mean survival time differences in years by the quintiles of deprivation (Q5 vs Q1). Solid line: differences, grey shaded area: 95% CI.
Figure 2
Figure 2
Sex-specific relative survival probability by deprivation (Q5 vs Q1) and age at cancer diagnosis among colorectal cancer patients in Granada, between 2011–2013, n = 3,582.
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