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. 2021 Jan-Dec:28:10732748211011956.
doi: 10.1177/10732748211011956.

Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review

Nina Afshar  1   2 , Dallas R English  1   3 , Roger L Milne  1   3   4
Affiliations

Factors Explaining Socio-Economic Inequalities in Cancer Survival: A Systematic Review

Nina Afshar et al. Cancer Control. 2021 Jan-Dec.

Abstract

Background: There is strong and well-documented evidence that socio-economic inequality in cancer survival exists within and between countries, but the underlying causes of these differences are not well understood.

Methods: We systematically searched the Ovid Medline, EMBASE, and CINAHL databases up to 31 May 2020. Observational studies exploring pathways by which socio-economic position (SEP) might causally influence cancer survival were included.

Results: We found 74 eligible articles published between 2005 and 2020. Cancer stage, other tumor characteristics, health-related lifestyle behaviors, co-morbidities and treatment were reported as key contributing factors, although the potential mediating effect of these factors varied across cancer sites. For common cancers such as breast and prostate cancer, stage of disease was generally cited as the primary explanatory factor, while co-morbid conditions and treatment were also reported to contribute to lower survival for more disadvantaged cases. In contrast, for colorectal cancer, most studies found that stage did not explain the observed differences in survival by SEP. For lung cancer, inequalities in survival appear to be partly explained by receipt of treatment and co-morbidities.

Conclusions: Most studies compared regression models with and without adjusting for potential mediators; this method has several limitations in the presence of multiple mediators that could result in biased estimates of mediating effects and invalid conclusions. It is therefore essential that future studies apply modern methods of causal mediation analysis to accurately estimate the contribution of potential explanatory factors for these inequalities, which may translate into effective interventions to improve survival for disadvantaged cancer patients.

Keywords: cancer survival; deprivation; disadvantage; disparity; inequality; socio-economic position.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow diagram describing selection of studies for inclusion in the systematic review of factors explaining socio-economic inequalities in cancer survival. CINAHL, Cumulative Index to Nursing and Allied Health Literature.
Figure 2.
Figure 2.
Directed acyclic graph (DAG) showing assumed causal associations between socio-economic position and cancer survival.
See this image and copyright information in PMC

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