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. 2021 Oct 14;13(20):5156.
doi: 10.3390/cancers13205156.

Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study

Laure Tron  1 , Mathieu Fauvernier  2   3 , Anne-Marie Bouvier  4   5 , Michel Robaszkiewicz  5   6 , Véronique Bouvier  1   5   7 , Mélanie Cariou  5   6 , Valérie Jooste  4   5 , Olivier Dejardin  1   8 , Laurent Remontet  2   3 , Arnaud Alves  1   8   9 , Francim Group, Florence Molinié  5   10   11 , Guy Launoy  1   5   8
Affiliations

Socioeconomic Environment and Survival in Patients with Digestive Cancers: A French Population-Based Study

Laure Tron et al. Cancers (Basel). .

Abstract

Social inequalities are an important prognostic factor in cancer survival, but little is known regarding digestive cancers specifically. We aimed to provide in-depth analysis of the contextual social disparities in net survival of patients with digestive cancer in France, using population-based data and relevant modeling. Digestive cancers (n = 54,507) diagnosed between 2006-2009, collected through the French network of cancer registries, were included (end of follow-up 30 June 2013). Social environment was assessed by the European Deprivation Index. Multidimensional penalized splines were used to model excess mortality hazard. We found that net survival was significantly worse for individuals living in a more deprived environment as compared to those living in a less deprived one for esophageal, liver, pancreatic, colon and rectal cancers, and for stomach and bile duct cancers among females. Excess mortality hazard was up to 57% higher among females living in the most deprived areas (vs. least deprived) at 1 year of follow-up for bile duct cancer, and up to 21% higher among males living in the most deprived areas (vs. least deprived) regarding colon cancer. To conclude, we provide a better understanding of how the (contextual) social gradient in survival is constructed, offering new perspectives for tackling social inequalities in digestive cancer survival.

Keywords: French cancer registries; cancer net survival; deprivation; digestive cancers; social gradient.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Net survival over time since diagnosis by level of deprivation for each cancer site for which EDI effect was significant, predicted by selected model for 70-year-old (a) males and (b) females. EDI: European Deprivation Index; mQi: median value of national deprivation quintile i (see Section 2).
Figure 1
Figure 1
Net survival over time since diagnosis by level of deprivation for each cancer site for which EDI effect was significant, predicted by selected model for 70-year-old (a) males and (b) females. EDI: European Deprivation Index; mQi: median value of national deprivation quintile i (see Section 2).
Figure 2
Figure 2
Excess hazard mortality ratio (EHR) between mQ5 (most deprived) and mQ1 (least deprived), over time for cancer sites for which effect of EDI on net survival was time-dependent (M1b selected). EHR: excess mortality hazard ratios; mQi: median value of national deprivation quintile i (see Section 2).
See this image and copyright information in PMC

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